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Fluorosis is widely prevalent worldwide, and China is one of the countries with a high incidence of endemic fluorosis. In recent years, study on non skeletal damage caused by fluorosis, especially cardiovascular system damage, has gradually increased. Fluoride can cause cardio vascular arteriosclerosis, hypertension and other diseases, while cardiovascular disease have hidden and acute onset, and the mortality rate has increased year by year in recent years. At present, the mechanism of cardiovascular diseases caused by fluoride is not yet clear, and further clarification is needed. This article provides an overview of the effects of fluoride on cardiovascular diseases from three aspect: epidemiological investigation, animals experiment, and in vitro cell experiment. It categorizes and analyzes the pathogenesis, providing new ideas for the study of cardiovascular system damage caused by fluorosis.
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Objective To study the effects of aneurysmal neck angle on stent displacement after endovascular repair of abdominal aortic aneurysm (AAA). Methods The CT images of 28 patients were selected to establish preoperative AAA model, postoperative AAA model and covered stent model respectively, and the models were divided into non-severe angulation group ( n = 14) and severe angulation group ( n = 14) according to the preoperative angle of tumor neck. The geometric shape of each model was measured, and the changes of AAA geometric parameters and postoperative stent displacements before and after surgery were analyzed. The displacement force of the model during the first follow-up was calculated by hemodynamic simulation. Results Significant differences were found in tumor length, maximum diameter, displacement force, tumor neck length and tumor volume between two groups of patients (P 0. 05). For the incidence of internal leakage, there were 2 cases in non-severe angulation group and 4 cases in severe angulation group (P>0. 05).Conclusions Severe neck angulation can lead to a significant increase in support displacement force and decrease in proximal anchorage zone, and thus increase the possibility of support displacement. It is suggested that doctors should strengthen postoperative follow-up for patients with severe neck angulation and be vigilant of the occurrence of long-term internal leakage in clinic.
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ObjectiveTo evaluate the effect of the therapy of dispelling stasis， removing toxin， and promoting urination （modified Linggui Zhugantang combined with Xuebijing injection） on the prognosis of sepsis-induced cardiomyopathy （SICM）. MethodA total of 96 patients were randomly assigned into an observation group and a control group， with 48 patients in each group. The patients in the control group received sepsis bundle， and those in the observation group additionally received the therapy of dispelling stasis， removing toxin， and promoting urination （intravenous drip of Xuebijing injection and oral administration of modified Linggui Zhugantang）. The course of treatment in both groups was 7 days. The disease and prognosis indicators ［28-day mortality， intensive care unit （ICU） length of stay， major adverse cardiac events （MACE）， acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ）， sequential organ failure assessment （SOFA） score， and mortality in emergency department sepsis （MEDS） score］， cardiac function indicators ［left ventricular ejection fraction （LVEF）， E/A ratio of peak velocity blood flow from left ventricular relaxation in early diastole （the E wave） to peak velocity flow in late diastole caused by atrial contraction （the A wave）， E/e′ ratio of mitral peak velocity of early filling （E） to early diastolic mitral annular velocity （e′）， and afterload-corrected cardiac performance （ACP）］， myocardial injury markers ［high-sensitivity cardiac troponin T （hs-cTnT）， N-terminal pro-brain natriuretic peptide （NT-proBNP）， heart-type fatty acid-binding protein （H-FABP）， and high mobility group box-1 （HMGB-1）］， hemodynamic indicators ［extravascular lung water index （EVLWI）， global end-diastolic volume index （GEDVI）， cardiac index （CI）， and systemic vascular resistance index （SVRI）］， and TCM syndrome scores were assessed and compared between the two groups. ResultThe 28-day mortality and the incidence of MACE in the observation group were slightly lower than those in the control group. The ICU length of stay in the observation group was shorter than that in the control group （P<0.05）. After treatment， APACHE Ⅱ， SOFA， MEDS， syndrome score of stasis-caused internal obstruction， E/e′ ratio， hs-cTnT， NT-proBNP， H-FABP， and HMGB1 decreased compared with those before treatment （P<0.05）， while LVEF， E/A ratio， and ACP increased （P<0.05）. Moreover， the changes were more significant in the observation group （P<0.05）. On days 3， 5， and 7 after treatment， the EVLWI and SVRI in the observation group were lower than those in the control group （P<0.05）， while CI showed an opposite trend （P<0.05）. The observation group had higher GEDVI than the control group on days 3 and 5 after treatment （P<0.05）. ConclusionOn the basis of conventional bundle therapy， modified Linggui Zhugantang combined with Xuebijing injection with the effect of dispelling stasis， removing toxin， and promoting urination can inhibit the generation of myocardial injury markers and improve hemodynamics to shorten the length of ICU stay， mitigate the TCM syndrome， and reduce the risk of death， thereby improving the prognosis of SICM.
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Objective:To systematically identify and summarizes the weaknesses of the key aspects of Investigator-Initiated Clinical Trial (IIT) quality management in China, and quantitatively assess these weaknesses with a synthesis of relevant evidence, thereby providing references for the subsequent establishment of a complete IIT quality management system in China.Methods:According to the Scoping review report checklist (PRISMA-ScR statement), we conducted a systematic literature retrieval and screening, data extraction, and result synthesis of IIT quality management issues after defining the research questions.Results:73 eligible studies were eventually included. It was found that the most frequently explored issues were a lack of guidance and support from methodological and statistical experts at the project initiation stage (60.9%), a lack of research funding or improper funding management at the project implementation stage (49.3%), mismanagement of archival materials at the project completion stage (70.0%). Meta-analysis results showed that after evidence synthesis, the incidence of irregular informed consent signing, untraceable raw data, delayed study progress, and protocol violation were all above 40%, but there was heterogeneity in the results.Conclusion:Some outstanding issues in IIT quality management need to be addressed. Future studies should conduct more practical research to obtain quantitative data, undertake demonstrative application of management protocols, further carry out pioneering exploration and research in the field of IIT quality management, and propose effective solutions and strategies to improve IIT quality.
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Objective To study the mock circulation system (MCS) which can accurately reproduce the human hemodynamic environment for in vitro test in the development of artificial organs such as ventricular assist devices (VAD) and artificial heart-lung machine.Methods A double-heart MCS including the systemic and pulmonary circulation was established, which basically covered the main physiological characteristics and functions of the cardiovascular system. The simulation of valves and arteries were proposed with a new way made of silicone material. The MCS could simulate a variety of physiological environments such as normal human body, heart failure, valvular diseases, arteriosclerosis and peripheral obstruction changes by adjusting the control system parameters or structural parameters.The sensor and control system were used to realize the real-time display, control and data preservation of pressure and flow.Results The MCS could simulate the hemodynamic environment of normal human body and a variety of diseases, which were basically consistent with the actual human condition. The new valve and artery model reduced pressure fluctuations in a much better way. The HeartCon VAD of RocketHeart was connected to the experimental platform under simulated state of heart failure, and the hemodynamic environment (aortic pressure, left atrial pressure, cardiac output, etc.) could all be recovered to the normal range.Conclusions The MCS can accurately reproduce the hemodynamic environment of body and pulmonary circulation under a variety of physiological states, and provide an effective experimental platform for the performance test and control strategy design of artificial organs such as VAD. At the same time, the simulation method of making valves and arteries with silicone material can also be further improved in MCS.
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Objective:To investigate the influence of different types of wound dressings on red light transmittance.Methods:A treatment environment for wounds exposed to red light was simulated.Red light transmittance of four types of 19 dressings commonly used in clinic were detected respectively and compared.The transmittance was calculated as the ratio of the intensity of the red light through the dressing to the intensity of the injected red light.Results:The red light transmittance for each dressing was the following: (1)Cotton gauze and pad: 29.4% for one piece of coarse gauze, 10.5% for one cotton pad; (2)Oil dressings: 73.0%~79.1% for light-color oil dressings, 41.7% for dark-color oil dressings-Atrauman ?; (3)Hydrocolloid dressings: 87.8%~90.2%; (4)Foams: 74.7% for light-color ultra-thin foam-Mepilex ? sheet, 0.8% for black-color thicker foam dressings-Mepilex ? Ag dressing, and 20.5%-54.2% for the other foam dressings. Conclusions:The red light transmittance of hydrocolloid dressing, light-colored oil gauze dressing and light-colored ultra-thin foam dressing is higher, with less red light-blocking effect, and the dark-color or thicker dressings had more blocking effect, which showed different therapeutic effect on wound.Gauze and cotton pad have great blocking influence on red light transmittance, and are not suitable for temporary covering of wound during red light treatment.Hence, the effect of wound dressing on red light transmittance should be taken into account when the wound is treated with red light.
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Objective:To investigate the value of total laparoscopic simultaneous resection for left-sided colorectal cancer (CRC) and synchronous liver metastases (SLM).Methods:A retrospective analysis of the clinical data of patients with left-sided CRC and SLM who underwent simultaneous resection in the Shanghai Cancer Center, Fudan University from March 2014 to December 2017. The patients were divided into laparoscopy group, open surgery group and hybrid surgery group. The intraoperative information, postoperative short-term outcome and long-term survival were analyzed among the three groups.Results:A total of 96 patients were enrolled. The total laparoscopic group enrolled 29 patients, including 21 males and 8 females, aged (57.8±1.6) years old; the open surgery group enrolled 28 patients, including 18 males and 10 females, aged (57.3±2.0) years old; 39 cases were included in the hybrid surgery group, including 27 males and 12 females, aged (55.3±1.8) years old. The distribution ratio of the two lobes of liver metastases in the open surgery group was higher than that in the total laparoscopic group and hybrid surgery group (all P<0.05), and there was no significant difference in the other clinical baseline characteristics between the three groups (all P>0.05). In laparoscopy group, open surgery group and hybrid surgery group, the mean operative time was (241.5±12.9) min, (209.3±10.7) min and (234.9±12.4) min, respectively. The median intraoperative blood loss was 200.0 ml, 300.0 ml and 200.0 ml, respectively. The median postoperative hospital stay was 8.0 days, 9.0 days and 9.0 days, respectively. There were no statistical differences in these indicators (all P>0.05). The patients in the open surgery group had a longer initial defecation time than those in the other two groups ( P<0.05). The incidence of postoperative complications was 31.0% (9/29), 39.3% (11/28) and 35.9% (14/39), respectively, with no difference among the three groups ( P>0.05). In laparoscopy group, open surgery group and hybrid surgery group, 1-year overall survival were 93.0%, 85.0% and 94.0%; 3-year overall survival were 72.0%, 81.0% and 74.0%, respectively ( P>0.05). One-year disease free survival were 70.0%, 52.0% and 55.0%; 3-year disease free survival were 36.0%, 30.0% and 39.0%, respectively ( P>0.05). Conclusion:Laparoscopic simultaneous resection for left-sided CRC and SLM shows slight advantages in the safety and short-term outcome, and does not affect the long-term survival.
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Objective:To compare laparoscopic versus laparotomy in the treatment of colorectal cancer liver metastases (CRLM).Methods:The clinical data of 78 consecutive patients with CRLM operated at Department of Hepatic Surgery, Fudan University Shanghai Cancer Center from April 2015 to August 2016 were analyzed retrospectively. There were 52 males and 26 females. The average was (56.8±9.9) years. The patients were divided into the laparoscopic group ( n=26) and laparotomy groups ( n=52). The operation time, intraoperative blood loss, extent of hepatectomy, postoperative liver function and complications were compared between the two groups. The follow-up data was used to compare the long-term survival outcomes. Results:There were no significant differences between the two groups in operation time, intraoperative bleeding volume and extent of hepatectomy ( P>0.05). The percentage of patients who underwent preoperative neoadjuvant chemotherapy in the laparotomy group was significant higher, and the diameter of liver metastasis was significantly larger than that in the laparoscopic group ( P<0.05). On day 1 after operation, the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in the laparoscopic group were (502.2±115.3) U/L and (570.4±132.4) U/L, respectively, which were significantly better than those in the laparotomy group (683.9±150.1) U/L and (739.5±230.2) U/L, respectively ( P<0.05). On day 3 after operation, the ALT and AST levels in the laparoscopic group were (263.3±83.3) U/L, (271.4±87.3) U/L, which were still significantly superior than those in the laparotomy group (410.8±128.4) U/L and (489.1±125.6) U/L ( P<0.05). Complications occurred in 4 patients (15.4%) in the laparoscopic group and 19 patients (36.5%) in the laparotomy group, the difference was significant ( P<0.05). The recurrence and extrahepatic metastasis rates of the laparoscopic group were better than those of the laparotomy group, and the survival outcomes were better than the laparotomy group. Conclusion:Laparoscopic surgery was better than laparotomy surgery in the treatment of CRLM. Laparoscopic surgery should be further promoted.
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Objective:To construct a complete, effective, multi-dimensional index system that reflects the general faculty's ability level and post competency, so as to select and train excellent general medical faculty.Methods:The weight of each index was determine by analytic hierarchy process. Through consulting the relevant literature and discussing by the research group, the original index system of the comprehensive indexes of the general clinical teachers was designed. Consultation and investigation were made on 8 experts of the general teaching management experts from affiliated hospitals of higher medical colleges, and a comprehensive primary indicator system of general clinical teachers was constructed. Letter consultation was given to 26 general education experts, and a three-level framework for the comprehensive index system of general clinical teachers was formulated. Questionnaires were distributed to 65 general clinical teachers, and Yaahp statistical software was applied to calculate the weight values of each indicator and perform a consistency check.Results:A comprehensive index system of general medical clinical teachers including 3 first-level indicators, 15 second-level indicators and 49 third-level indicators was constructed, and the weight values of each indicator were calculated.Conclusion:The general medical clinical teacher qualification index system developed in this study has a high feasibility, which provides a theoretical basis for the construction of general medical clinical teacher team.
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Objective:To evaluate the safety, feasibility and operational performance of self-developed medical disposable portable endoscopy (YunSendo) for upper gastrointestinal endoscopy examination in Ba-Ma mini-pigs.Methods:A total of 10 Guangxi Ba-Ma mini-pigs were used in the experiment, and mucosal injury models were established in advance by biopsy forceps in esophagus, stomach, and duodenum. Each experimental animal underwent medical disposable portable endoscopy and Olympus endoscopy (GIF-Q260J) performed by two endoscopists separately. The time when the endoscope reached the duodenum, the number of detected mucosal injuries and endoscopic pictures of different parts with standard image acquisition were recorded. Endoscopic operational performance and endoscopic image quality were evaluated. Different endoscopists recorded experimental results with blind method. The procedures of the two endoscopic examinations were performed by coin-tossing method. The paired t test was used for statistical analysis. Results:There were no statistically significant differences in the insertion time and total operation time between medical disposable portable endoscopy and Olympus endoscopy ( (171.00±9.96) s vs. (164.00±17.84) s, (285.00±33.94) s vs. (273.40±23.46) s; t=1.289 and 1.281, P=0.230 and 0.232). There were no statistically significant differences in the percentage of time of clear visual field during endoscopy insertion and total operation between medical disposable portable endoscopy and Olympus endoscopy ((91.83±1.85)% vs. (91.52±1.51)%, (93.07±3.10)% vs. (92.06±2.57)%; t=0.401 and 0.689, P=0.698 and 0.508). Moreover, there were no statistically significant differences in the score of comprehensive operation performance, score of clear image number, score of image color recognition, score of image illumination, comprehensive score of image quality and number of detected mucosal injuries ((9.66±0.30) points vs. (9.86±0.15) points, (39.50±0.71) points vs. (39.30±1.06) points, (39.70±0.48) points vs. (39.40±0.70) points, (39.40±0.70) points vs. (39.50±0.71) points, (9.88±0.09) points vs. (9.85±0.20) points, 9.80±0.42 vs. 9.90±0.32; t=2.176, 1.000, 1.152, 0.317, 0.629 and 0.557, all P>0.05). There were no adverse events after operation in medical disposable portable endoscopy group and Olympus endoscopy group. Conclusions:The medical disposable portable endoscopy is safe and feasible for endoscopy examination in live animal models. Different parts of upper gastrointestinal tract and mucosal lesions can be clearly detected. The operational performance and the image quality are excellent, which is similar to Olympus endoscopy (GIF-Q260J).
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Objective@#To investigate the effects of different expression of monoacylglycerol lipase (MAGL) in tumor-associated macrophages (TAMs) with the proliferation of MHCC97H human liver cancer cells in vivo and its mechanism.@*Methods@#Human peripheral blood-derived monocyte was induced to differentiate into M2-type TAMs and was identified by flow cytometry. The co-culture model of TAMs and MHCC97H human liver cancer cells was established, and the expression of MAGL in TAMs cells was detected by qRT-PCR. The expression of MAGL in TAMs cells was detected by plasmid transfection. ELISA and qRT-PCR was used to detect the mRNA expression levels and secretion levels of inflammatory factors in TAMs cells. The subcutaneous tumor model of MHCC97H mice was constructed to observe the effect of different expression of MAGL in TAMs cells with the proliferation of MHCC97H human liver cancer cells in vivo. F-test was used for the measurement of homogeneity of variance between two independent samples. A t-test was used for homogeneity of variance, and the corrected t-test was used for non-homogeneity of variance.@*Results@#Human peripheral blood-derived monocytes were successfully induced to differentiate into M2-type TAMs. An in vitro co-culture model was established. qRT-PCR showed that MHCC97H human liver cancer cells significantly down-regulated the expressional level of MAGL in TAMs cells. The constructed subcutaneous tumor model of mice demonstrated that up-regulation up-regulation of MAGL expression in M2-type TAMs inhibited the proliferation of MHCC97H human liver cancer cells in vivo. Furthermore, the mechanistic study illustrated that the high expression of MAGL promoted the transcription and secretion of inflammatory factors such as interleukin-1 beta, interleukin-6 and tumor necrosis factor-alpha in M2-type TAMs cells.@*Conclusion@#The overexpression of MAGL inhibits the proliferation of MHCC97H hepatocellular carcinoma cells in vivo, and its mechanism may be associated to the release of inflammatory factors that from TAMs cells.
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Objective@#To explore the correlation and consistency between thromboelastography (TEG) and traditional coagulation tests (CCTs) in ischemic cerebral vascular disease (ICVD).@*Methods@#Totally 108 ICVD patients admitted to Nanyang Central Hospital from May 1 to October 31 2018 were enrolled. Patients’ TEG parameters (R value, K value, Angle value, MA value, CI value and G value) and CCTs parameters (PT, APTT, TT, and FIB) were collected and analyzed retrospectively. The Spearman correlation coefficient was used to explore the correlation between TEG and CCTs parameters, and Kappa (κ) to explore the consistency in determining the coagulation status of the patients. The ROC curve was used to analyze the predictive value of TEG parameters for abnormal results of CCTs, and the results of TEG and CCTs were comprehensively analyzed to evaluate the ability to predict the coagulation status of patients.@*Results@#(1) PLT was positively correlated with MA value and G value; PT and APTT were positively correlated with K value; TT was positively correlated with R value and K value; FIB was positively correlated with Angle value, MA value and G value. TT was negatively correlated with Angle value and CI value; FIB was negatively correlated with K value. (2) PT and MA values, PT and G values, FIB and MA values, FIB and G values were accordant in valuing the hypoxic state of ICVD patients. (3) PLT and Angle values, PLT and MA values, PLT and CI values, PLT and G values were accordant in assessing hypercoagulable status of ICVD patients; FIB and Angle values, FIB and MA values, FIB and CI value, and FIB and G value were consistent in evaluating the hypercoagulable state of ICVD patients. (4) For detecting TT>20 s, the AUC of K value and Angle value were 0.648, 0.651, respectively; For detecting FIB>4 g/L, the AUC of Angle value and MA value were 0.717 and 0.747, respectively; For detecting PLT>300×109/L, the AUC of MA value was 0.808 (all P<0.05).@*Conclusions@#There is weak correlation and consistency between TEG and CCTs parameters in ICVD patients. The TEG parameters have good predictive value in evaluating the abnormal results of CCTs, but cannot replace the CCTs. Combination of these two methods can better reflect the coagulation status of patients, so as to afford assistance.
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Von Willebrand Factor (VWF) is a multimeric glycoprotein produced by endothelial cells, which increases in thrombogenicity especially under high shear rates. It bridges between vascular platelets and sub-endothelial collagen. There is abnormal VWF level in ischemic stroke patients, and VWF shows unique significance in valuing the prediction, treatment and prognosis of ischemic stroke. Numerous basic and clinical evidences suggest that VWF is a potential target for ischemic stroke treatment. In recent years, researches on VWF for prevention and treatment of ischemic stroke have been rapidly developed. The findings in this field are reviewed in this paper.
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Objective To explore the correlation and consistency between thromboelastograpby(TEG)and traditional coagulation tests(CCTs)in ischemic cerebral vascular disease(ICVD).Methods Totally 108 ICVD patients admitted to Nanyang Central Hospital from May 1 to October 31 2018 were enrolled.Patients' TEG parameters(R value,K value,Angle value,MA value,CI value and G value)and CCTs parameters(PT,APTT,TT,and FIB)were collected and analyzed retrospectively.The Spearman correlation coefficient was used to explore the correlation between TEG and CCTs parameters,and Kappa(κ)to explore the consistency in determining the coagulation status of the patients.The ROC curve was used to analyze the predictive value of TEG parameters for abnormal results of CCTs,and the results of TEG and CCTs were comprehensively analyzed to evaluate the ability to predict the coagulation status of patients.Results(1)PLT was positively correlated with MA value and G value; PT and APTT were positively correlated with K value; TT was positively correlated with R value and K value; FIB was positively correlated with Angle value,MA value and G value.TT was negatively correlated with Angle value and CI value; FIB was negatively correlated with K value.(2)PT and MA values,PT and G values,FIB and MA values,FIB and G values were accordant in valuing the hypoxic state of ICVD patients.(3)PLT and Angle values,PLT and MA values,PLT and CI values,PLT and G values were accordant in assessing hypercoagulable status of ICVD patients; FIB and Angle values,FIB and MA values,FIB and CI value,and FIB and G value were consistent in evaluating the hypercoagulable state of ICVD patients.(4)For detecting TT＞20 s,the AUC of K value and Angle value were 0.648,0.651,respectively;For detecting FIB＞4 g/L,the AUC of Angle value and MA value were 0.717 and 0.747,respectively; For detecting PLT＞ 300× 109/L,the AUC of MA value was 0.808(all P＜0.05).Conclusions There is weak correlation and consistency between TEG and CCTs parameters in ICVD Patients.The TEG parameters have good predictive value in evaluating the abnormal results of CCTs,but cannot replace the CCTs.Combination of these two methods can better reflect the coagulation status of patients,so as to afford assistance.
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Von Willebrand Factor (VWF) is a multimeric glycoprotein produced by endothelial cells, which increases in thrombogenicity especially under high shear rates. It bridges between vascular platelets and sub?endothelial collagen. There is abnormal VWF level in ischemic stroke patients, and VWF shows unique significance in valuing the prediction, treatment and prognosis of ischemic stroke. Numerous basic and clinical evidences suggest that VWF is a potential target for ischemic stroke treatment. In recent years, researches on VWF for prevention and treatment of ischemic stroke have been rapidly developed. The findings in this field are reviewed in this paper.
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Hepatic diseases refer to acute and chronic liver disease linked to all kinds of hepatic pathological changes. Viral hepatitis, bacterial infections, endotoxins and other factors initiate the activation and injury of vascular endothelial cells in patients with liver diseases. Von Willebrand factor (vWF) represents a specific marker of endothelial dysfunction and plays a vital role in the occurrence and development of hepatic diseases. This paper reviews the research progress of the relationship between vWF and hepatic diseases.
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Objective To investigate the risk factors of postoperative cardiovascular complica-tions in elderly patients with hip fracture during hospitalization.Methods A retrospective analysis was conducted according to the medical records of 693 elderly patients with hip fracture admitted to our hospital from January,2005 to December,2015.There were 257 males and 436 females,aged 65-103 years and body mass index (BMI)16.5-33.1 kg/m2,ASA physical status Ⅱ-Ⅳ.The demo-graphic data,preoperative comorbidities,time before surgery,surgical types,anesthetic methods, operation time and blood loss were recorded.Multivariate logistic regression analysis was applied to analyze the risk factors of postoperative cardiovascular complications in elderly patients with hip frac-ture during hospitalization.Results Postoperative cardiovascular complications occurred in 46 (46/693,morbidity:6.64%),including angina pectoris,arrhythmia,heart failure,myocardial infarction and sudden cardiac death.Univariate analysis showed that the independent variables of postoperative cardiovascular complications were age,cardiac comorbidities,hypertention,diabetes mellitus,cere-brovascular disease,renal insufficiency and anesthetic methods (P < 0.05).Multiple logistic regression analysis showed that age(OR=1.11,95% CI 1.06-1.17,P<0.001),cardiac comorbidi-ties (OR=1.98,95% CI 1.02-3.85,P=0.045),hypertention(OR=2.61,95% CI 1.23-5.51,P=0.012),diabetes mellitus (OR=2.06,95% CI 1.04-4.09,P=0.039),cerebrovascular disease (OR=2.14,95% CI 1.06-4.32,P=0.033)and renal insufficiency (OR=17.42,95% CI 3.69-82.80,P<0.001)were independent risk factors for postoperative cardiovascular complications in elderly patients with hip fracture during hospitalization.Conclusion Age,cardiac comorbidities,hy-pertention,diabetes mellitus,cerebrovascular disease and renal insufficiency are independent predictors for postoperative cardiovascular complications in elderly patients with hip fracture during hospitalization.
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Objective To compare combined spinal-epidural anesthesia (CSEA) versus lumbar plexus-sciatic nerve block (LPSB) in elderly patients undergoing internal fixation of hip fractures.Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients,aged 66-94 yr,with body mass index of 15.2-28.0 kg/m2,scheduled for internal fixation of hip fractures,were randomly assigned into CSEA group and LPSB group using SPSS 18.0 software,with 30 patients in each group.In CSEA group,intrathecal catheter was successfully placed at L3,4 interspace,0.5％ hyperbaric bupivacaine 8-10 mg was injected into the subarachnoid space and then an epidural catheter was placed.In LPSB group,posterior lumbar plexus block was performed with 0.4％ ropivacaine 25-30 ml and parasacral sciatic nerve block with 0.4％ ropivacaine 15-20 ml.Dexmedetomidine 0.4-0.6 μg · kg-1 · h-1 was infused during the procedure to maintain the Observer's Assessment of Alertness/Sedation Scale score of 3 or 4 in two groups.Patient-controlled intravenous analgesia was performed with sufentanil and lasted for 48 h.The anesthesia time,volume of intraoperative fluid infused,blood loss,consumption of dexmedetomidine,requirement for vasoactive agents,cardiovascular events,consumption of sufentanil within 24 and 48 h after surgery,rescue analgesia and postoperative adverse reactions were recorded.Results Compared with CSEA group,the anesthesia time was significantly prolonged,the volume of intraoperative fluid infused and consumption of ephedrine were reduced,the consumption of dexmedetomidine was increased,the incidence of bradycardia was decreased,the postoperative consumption of sufentanil was reduced,the rescue analgesia rate was decreased,and no significant change was found in the incidence of postoperative adverse events in LPSB group (P＞0.05).Conclusion LPSB can maintain hemodynamics stable and provide postoperative analgesic effect,with better anesthetic efficacy than CSEA when used for internal fixation of hip fractures in elderly patients.
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Objective To compare the time consumed for the procedure done,satisfaction and safety of the establishment of intraosseous (IO) access and central intravenous line placement (CVL) in critically ill patients using a randomized controlled trial.Methods The patients were randomly divided into the IO access group versus CVL group according to the inclusion criteria.The IO access and CVL were established,respectively for medicine or fluid administration.The success rates at the first attempt,time required for procedure completed,satisfaction and complications were recorded.Results During the study period,24 patients were enrolled,and divided equally and randomly into IO group (n=12) and CVL group (n=12).There were no significant differences in age,gender,BMI between the two groups.The patients with shock and cardiac arrest accounted for 83.3 ％ in IO group and 58.3 ％ in CVL group,respectively.The success rates at the first attempt was 91.7 ％ in IO access group versus 66.7 ％ in CVL group (P=0.158).the time required for procedure done was significantly shorter in IO access group (74.9 ±43.7)s compared with CVL group (944.0 s±491.5 s) (P＜0.01).The satisfaction of operators at the instruments used was 8.0±1.1 for IO access group versus 7.2±0.8 for CVL group (P==0.053).The overall satisfaction of the operators at the entire course of procedure was 3.7 + 0.7 in IO access group versus 3.9±0.3 in CVL group (P=0.377).Complications were not observed during the study period in the two groups.Conclusions The success rate at the first attempt was significantly higher in IO access group compared with CVL grouThe mean time consumed for procedure completed in IO group was much shorter than that in CVL group,and the operation was simple and practicable.During the emergency care of critical patients,if the peripheral intravenous line placement was difficult to establish,and IO access could be a choice of alternative used as a bridging procedure to rapidly establish the vascular access and win the rescue opportunity.
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Background and purpose: With the application of laparoscopy in the liver surgery increasingly widely used, the safety and feasibility of laparoscopic liver resection is gaining recognition gradually. This study aimed to explore the laparoscopic liver resection for the tumor and the feasibility of open liver tumor resection and clinical curative effect. Methods: We retrospectively analysed the clinical data from 37 cases of laparoscopic hepatectomy and 74 patients with open liver resection from Mar. 2015 to Mar. 2016. Measurement data by covariance analysis were obtained, and comparison between groups were made using independent sample with Wilcoxon rank test and statistical value of Z. We collected data including operation time, intra-operative blood loss, post-operative recovery time of gastrointestinal tract, surgical drainage tube after extubation time, length of hospital stay, postoperative complications, hospitalization expenses and other clinical data. Laparoscopic group had 20 males and 17 female aged 18 to 76 (median age 55). Open group had 42 males and 32 females aged 26 to 74 (median age 54). The hepatectomy included ultrasonic knife + unipolar electric coagulation, combined with laparoscopic incision suture. Surgery procedures included 13 cases of local excision in laparoscopic group and 24 cases of liver segment or lobe anatomical resection. Open group had 33 cases of local excision and 41 cases of liver segment or lobe anatomical resection. Results: The average duration of laparoscopic hepatectomy was 149 min (40-204 min). The average duration of open hepatectomy was 142 min (45-190 min). The average intra-operative blood loss was 220 mL (30-570 mL) in laparoscopic group and 360 mL (90-970 mL) in open group. The average length of hospital stay was 4.9 d (3-6 d) in laparoscopic group and 6.8 d (5-9 d) in open group. Gastrointestinal average recovery time was 1.1 days in laparoscopic group and 2.3 days in open group. The average hospitalization expenses were 38760 yuan in laparoscopic group and 39145 yuan in open group. Conclusion:Laparoscopic hepatectomy is a safe, effective and minimally invasive surgery, can be safely used in local, liver segment and half liver resection, worthy of promotion.