ABSTRACT
Objective To evaluate the efficacy of noninvasive positive-pressure ventilation (NPPV) on acute respiratory failure (ARF) in elderly patients with severe community-acquired pneumonia (CAP).Methods 321 CAP patients with ARF aged over 65 years [(75.6±12.2) years old in averag] were randomly treated with NPPV (n=162) and the standard oxygen therapy (n=159).Intubation rate,ARF control rate and total mortality were compared between the two groups,and the risk factors were analyzed.Results 90％ of 321 patients presented with hypoxemic respiratory failure.Compared with standard therapy group,the intubation rate was lower in NPPV group (46.9％ vs.64.2％,x2=9.652,P＜0.01).However,there were no differences in ARF control rate(77.9％ vs.72.3％,x2 =1.274,P＞0.05),overall 30-day mortality and 90-day survival between the two groups.The overall mortality in NPPV group was higher in treatment failure cases than in treatment success cases (48.7％ vs.11.6％,x2=26.900,P＜0.01).The independent risk factors for death were treatment failure in NPPV,higher simplified acute physiology score assessment,old age and mutilobar infiltrate.Conclusions NPPV can decrease the intubation rate in CAP patients with acute hypoxemic respiratory failure,but the overall efficacy is not significant.Delayed intubation should be avoided when NPPV is to be applicated.
ABSTRACT
OBJECTIVE@#To assess the value of proximal gastrectomy (PG) and total gastrectomy (TG) for the treatment of cancer of cardia and fundus.@*METHODS@#Publications on comparision between PG and TG in the treatment of cancer of cardia and fundus were collected, the data from the publications were matched with the PG group and the TG group respectively according to its corresponding surgical resection, and the data on postoperative complications, motality and 5-year survival rate were meta-analyzed by fixed effect model and random effect model.@*RESULTS@#Thirteen reseaches on 2 219 patients were included in this study, 2 of which were randomly controlled studies. There were no significant differences in the postoperative complications (OR=1.00, 95%CI: 0.44-2.28,P>0.05) and mortality (OR=1.25, 95%CI: 0.62-2.48,P>0.05) between the PG group and the TG group, while there was significant difference in the 5-year survival rate (HR=0.87, 95%CI: 0.76-0.99,P=0.04). The 5-year survival rate in the TG group was higher than that in the PG group.@*CONCLUSION@#Total gastrectomy for the treatment of cancer of cardia and fundus has better long-term therapetic effect.
Subject(s)
Humans , Cardia , Pathology , Gastrectomy , Methods , Gastric Fundus , Pathology , Prognosis , Stomach Neoplasms , Mortality , General Surgery , Survival RateABSTRACT
AIM: To investigate neutrophil(PMN) apoptosis in bronchoalveolar lavage fluid(BALF) in the course of acute lung injury(ALI). METHODS: A rat model of ALI was established by the "two-hit" method,acid instillation and subsequent lipopolysaccharide challenge. At different time,PMN from the BALF and normal peripheral blood were incubated in BALF from normal rats or rats with ALI.PMN apoptosis was determined by flow cytometric analysis of annexin V binding, and interleukin-1?(IL-1?) mRNA was measured in PMN by PCR. RESULTS: Incubated with BALF from ALI ,PMN apoptosis was delayed with elevated expression of IL-1?, and there was a significant negative correlation between the percentage of apoptotic PMN and IL-1? level. CONCLUSION: Neutrophil apoptosis is delayed during ALI, which might have relevance to elevated expression of IL-1?.