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Objective To study the safety,efficacy and advantages of enhanced recovery after surgery (ERAS) combined with clinical pathway management in laparoscopic common bile duct exploration and lithotomy (Laparoscopic common bile duct exploration,LCBDE).Methods 78 patients who underwent LCBDE in the Department of Hepatobiliary and Pancreatic Surgery in the First Hospital of Fuyang District in Hangzhou were selected as the non-ERAS group (the control group).76 patients who underwent LCBDE treated with fast track surgery and ERAS clinical pathway management were selected as the ERAS group.The data between the two groups which included the postoperative insulin resistance index,changes in C-reactive protein,duration of postoperative analgesic use and analgesia,timing of first passage of postoperative flatus,postoperative abdominal tube removal,postoperative bile leakage,recurrence of biliary stones,intestinal ileus and other complications.Results All the two groups were discharged home successfully.On preoperative 7 day,the differences on the postoperative insulin resistance index and the levels of C reactive protein were significantly different (P＜0.05).The time to first get out of bed after operation,the postoperative analgesic use,the time to first passage of flatus,the time to postoperative abdominal drainage tube removal,and the time to clamping of the T tube after operation were significantly different (all P＜0.05).The postoperative complications of pulmonary infection,abdominal infection and the incidence of prolonged intestinal ileus were significantly different (all P＜0.05).Conclusions ERAS combined with clinical pathway management reduced postoperative stress reaction and complication rate.The treatment accelerated recovery and shortened hospital stay for patients who underwent LCBDE,which led to good social and economic benefits.
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Background:Screening of colorectal cancer (CRC) and colorectal adenoma (CRA), the precursor of CRC, is crucial for CRC prevention.It is believed that opportunistic screening of CRC in high risk population would narrow down the screening scope and save the health resources, and is suitable for the present status in China.Aims:To analyze the performance of high risk factors in predicting CRC/CRA, for exploring the feasibility of opportunistic screening for CRC in high risk population.Methods:A total of 1 862 outpatients and health examination subjects undergoing colonoscopy from Feb.2015 to Aug.2016 at the PLA 281 Hospital were recruited and asked to complete a questionnaire of high risk factors for CRC and CRA before colonoscopy.The questionnaire was designed based on the updated consensus on the screening and management of early colorectal cancer and precancerous lesion in China.Using the results of colonoscopy as gold standard, the predictive performance of high risk factors for CRC/CRA was analyzed.Results:Four hundred and sixty-eight (25.1%) individuals with high risk factors for CRC/CRA were screened out by the questionnaire.The detection rate of CRC in individuals with high risk factors was significantly higher than those without (17.5% vs.0.9%, P=0.000).The sensitivity, specificity, positive and negative predictive values of high risk factors in predicting CRC were 87.2%, 78.2%, 17.5% and 99.1%, respectively, and the missed diagnosis rate was 12.8%.For CRC/CRA, the corresponding figures were 83.2%, 87.0%, 57.3%, 96.1% and 16.8%, respectively.The risk ratios (RR) of high risk factors for CRC and CRC/CRA were 20.35 and 14.78, respectively.Conclusions:Opportunistic screening of CRC in high risk population is feasible and applicable in China under present condition.
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Background:Detection and removal of colorectal polyp by colonoscopy is of great importance for prevention of colorectal carcinoma. Aims:To investigate whether the clinical symptoms of patients undergoing colonoscopy may hint colorectal polyp and carcinoma,and provide reference for candidate selection in colonoscopic screening. Methods:A total of 2 366 patients undergoing colonoscopy were recruited and the history information such as symptoms at outpatient visits, site and nature of the lesions was collected for analyzing the detection rates of colorectal polyp and carcinoma and the correlations of clinical symptoms with the risk and site of the disease. Results:The overall detection rates of colorectal polyp and carcinoma were 20. 5% and 5. 4% ,respectively,in 2 366 patients. The detection rates were significantly higher in symptomatic patients than those in asymptomatic patients(24. 2% vs. 4. 5% for polyp and 6. 4% vs. 0. 9% for carcinoma,P all = 0. 000). Moreover,when patients were classified by major symptoms,the detection rate of colorectal polyp was significantly increased in patients with diarrhea(OR = 1. 213),hematochezia(OR = 2. 076),and changing of stool consistency(OR = 1. 503)(P all < 0. 05),and the detection rate of colorectal carcinoma was significantly increased in patients with abdominal pain( OR = 1. 568),hematochezia( OR = 2. 837),changing of stool consistency( OR =2. 206),and tenesmus( OR = 1. 735)( P all < 0. 05). The major symptoms being hematochezia,changing of stool consistency and tenesmus were associated with lesions locating at rectum or left hemicolon(P all < 0. 05). Conclusions:Diarrhea, hematochezia and changing of stool consistency hints risk for colorectal polyp, while abdominal pain, hematochezia,changing of stool consistency and tenesmus hints risk for colorectal carcinoma. Colonoscopy is strongly recommended for patients with these symptoms.
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Objective To evaluate the effects of sevoflurane on learning and memory of neonatal mice .Methods 122 neonatalmice (7 days postnatal) were included in this study .72 of them were exposed to sevoflurane (1 .0 or 0 .5MAC ,minimum alveolar concentration) or 40% O2 for 2 h(hours) .Morris water maze was performed 4 and 12 weeks after anesthesia .Latency and swimming speed during training ,time on island and times across island during the research were recorded .The rest 50 mice was used in artery blood analysis during sevoflurane (1 .0 or 0 .5 MAC ,0 ,1 ,2 h) .Results pH ,PaO2 ,PaCO2 ,SaO2 were stable during anesthesia .Latency in control group were significantly shorter than the two anesthesia groups 4 weeks after anes-thesia and 3 days after the training .During the last 2 training days ,the latency in 1 .0 MAC sevoflurane-exposed mice were sig-nificantly longer than that of the 0 .5 MAC group .12 weeks after anesthesia ,the latency was still significantly longer in 1 .0 MAC sevoflurane-exposed mice on the last training day .The time on island and/or times across island were significantly decreased in anesthesia groupsduring theresearch performed 4 weeks and 12 weeks after anesthesia .Conclusion Early exposure to sevoflurane leads to a concentration and time-depended persistent learning and memory deficits to neonatal mice .
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Objective To explore the approaches to improve the detection of early gastric and precancerous lesions for basic level hospi-tals. Methods The 72 patients with abnormal gastric mucosa observed by gastroscope arranged with pathology after acetic acid-indigo car-mine dyeing were considered as the dyeing group, and 68 patients with abnormal gastric mucosa observed by gastroscope directly arranged with pathology were considered as the control group. The dyeing conditions of gastric mucosa were observed and compared to pathology detec-tion. The detection rate of early gastric cancer and precancerous lesions in the two groups were compared. Results After acetic acid-indigo carmine dyeing, there were 16. 7% of demonstrated discoloration, 63. 9% of poor dyeing, and 14. 3% of even dyeing. The detection rate of early gastric cancer and high grade intraepithelial neoplasia in patients with mucosa discoloration (91. 7%) was obviously higher than that in patients with poor dyeing (8. 6%) or even dyeing (0. 0%). The detection rate of low grade intraepithelial neoplasia or intestinal metaplasia in patients with poor dyeing (82. 6%) was obviously higher than that in patients with mucosa discoloration (8. 3%) or even dyeing (14. 3%). The detection rate of early gastric cancer and precancerous lesions in dyeing group (13. 9%,63. 9%) was obviously higher than that in control group (2. 9%,29. 4%). Conclusion The acid-indigo carmine dyeing could increase the diagnosis of early gastric cancer and precancerous lesions in basic level hospital. It is adaptable to extend approach in basic level hospital for its low cost and simple operation.
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Objective To explore the effect of enalapril combined with folate acid on endothelial function and urine microalbumin(UMA) in patients with hypertension.Methods 120 patients with hypertension were randomly divided into two groups:control group (n =60) was given enalapril 10.0mg/d,observation group (n =60) received enalapril 10.0mg + folic acid 0.4mg/d.The total treatment period was 8 weeks.Blood pressure,plasma homocysteine (Hcy),flow mediated dilation (FMD) and UMA were examined.Results The efficacy of pressure releasinghad no significant difference between two groups.Hcy[(10.2 ± 5.8) μmol/L vs (16.6 ±-8.1) μmol/L,t =3.641],FMD[(14.8 ±5.4)％ vs (8.2±3.5)％,t =7.325] and UMA[(14.8 ±5.4)mg/L vs (31.6 ±9.5)mg/L,t =8.221] of two groups were significantly different after treatment.Conclusion Combination therapy of enalapril and folate acid can decrease plasma Hey and UMA,restore vascular endothelium function in patients with hypertension.
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BACKGROUND: Extracorporeal shock wave therapy is indicated as an effective method for treatment of delayed fracture healing or nonunion. Osteoblasts plays an important role in this process.OBJECTIVE: To investigate the function of osteoblasts in the process of extracorporeal shock wave promoting fractures healing, and to provide theoretical support for improving shock wave therapy on fracture healing.METHODS: Primary cultured ostsoblasts were isolated from newbon SD rat calvaria and randomly divided into two groups, shock wave and control. Treated by different energies of extracorporeal shock wave, cells were incubated onto 96-well culture plate. An optimal dose of extracorporeai shock wave was selected according to survival and proliferation of osteoblasts. The osteoblasts treated by optimal energy of extracorporeal shock wave were cultured and harvested for the analysis of alkaline phosphatase by calcium cobolt stain, cell survival by CCK-8 Kit, alkaline phosphatase expression by AKP kit, mineralized nodules by Alizarin red staining, integrin β1 and β1 mRNA expressions by flow cytometry and RT-PCR, cell migration by wound healing assay.RESULTS AND CONCLUSION: The optimal energy of extracorporeal shock wave treating primary cultured osteoblasts was 10 kV (500 impulses). Following extracorporeal shock wave therapy, the cell proliferation, alkaline phosphatase activity, cell mineralization, rates of cell adhesion, as well as β1 integrin and its mRNA expressions were increased as compared with those in control group (P ＜ 0.01). Further distance of cell migration was found in extracorporeal shock wave group (P ＜ 0.05). The results showed that the optimal energy of extracorporeal shock wave could promote the proliferation, differentiation, adhesion and migration of osteoblasts in vitro, and β1 integrin may play an important role in the process of cell adhesion and migration.
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Objective To determine the effectiveness and safety of prophylactic intravenous ibuprofen compared to placebo/no intervention on the prevention of patent ductus arteriosus(PDA) in preterm infants.Methods Randomized controlled trials(RCT) or quasi-RCT comparing prophylactic intravenous ibuprofen versus placebo/no treatment for prevention of PDA in preterm infants were enrolled. The standard search strategy included electronic search and manual search. Electronic search was carried out in databases including PubMed,ScienceDirect, EMBASE, OVID, Cochrane Library, VIP Chinese Periodical Database and Chinese Digital Hospital Library (www. chkd. cnki. net) without language restriction. As a supplementation,references in previous reviews and studies identified as relevant had been examined by manual search. RevMan 5.0. 21 was used in the statistical analysis. Effects were expressed as weighted mean difference (WMD) and 95% confidence interval (CI) for continuous data while risk ratio (RR) and 95%CI for categorical data.Results Four studies qualified for this meta-analysis including three graded 4 and one graded 3 with Jadad scale. Prophylactic use of ibuprofen significantly decreased the incidence of PDA on day three (RR=0. 40,95 % CI: 0. 31-0. 51, P＜0.01 ), the need for rescue treatment with cyclo-oxygenase inhibitors (RR = 0. 18,95 % CI:0. 07-0. 45, P = 0. 0003) and the need for surgical ligation (RR = 0. 34,95 % CI: 0. 14-0. 81, P =0. 02) in the prophylactic group. No significant difference of pulmonary, cerebral, gastrointestinal, and renal complications were found between the prophylactic and control groups. Conclusions Prophylactic intravenous ibuprofen significantly reduces the risk of PDA on day three, decreases the need for rescue treatment with cyclo-oxygenase inhibitors and surgical ligation without significant pulmonary, cerebral,gastrointestinal, and renal complications were seen in the prophylactic group. Due to the limits of evidences to date, prophylactic ibuprofen intravenously for prevention of PDA in preterm infants is not recommended.
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OBJECTIVE:To analysis the distribution and antibiotic resistance of common isolated pathogenic bacteria in urinary-tract infection cases in our hospital so as to provide scientific basis for the rational clinical use of antibacterials.MET-HODS:625 urine samples were collected from urinary-tract infection cases in our hospital in 2006,from which,344 strains of bacteria were isolated,which were cultured and subjected to drug sensitivity test.RESULTS:Of the 344 strains of bacteria,Gram-negative bacilli took the lead,accounting for 60.2% of the total,followed by Gram-positive cocci(33.4%) and fungi(6.4%).The detection rates of ESBLs-producing Escherichia coli.and Klebsiella pneumoniae were 49.2% and 27.3%,respectively.The bacteria had different resistant rate to different antibiotics and were multidrug resistant.CONCLUSION:Bacterial culture of urine and drug-sensitivity test should be performed promptly and drugs should be used with prudence for urinary infection cases to reduce drug-resistance bacteria.
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Objective: To observe the role of alanylglutamine(Ala-Gln)-supplemented hypocaloric nutrition support in severe brain injury.Methods: 60 cases of severe brain injury were randomly divided into experimental group and control group.The experimental group was treated with peripheral parenteral nutrition support of 105 kJ/(kg?d) and administration of alanylglutamine for 8 days.The control group was treated with peripheral parenteral nutrition support of 146 kJ/(kg?d) for 8 days.Blood glucose,serum albumin,transferin,hemoglobin,nitrogen balance,IgA,IgG,IgM,CD4(%) and CD8(%)were detected before and after nutrition support.Results: Compared with control group,IgA,IgG,CD4(%),CD4/CD8 in experimental group increased significantly(P
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Objective: To study the effect of Astragalus-supplemented enteral nutrition on nutritional metabolism in type-2 diabetic patients with ischemic stroke . Methods: 64 cases of type-2 diabetic patients with ischemic stroke were randomly divided into treatment group and control group. The treatment group was treated with homogenized diet and Radix Astragalis(equivalent to 60g crude drug), and the control group was treated with homogenized diet. Two groups were treated with nutrition support of 105kJ/(kg?d) for 30 days. The levels of fasting and postprandial blood glucose、insulin、blood lipids、serum proteins and nitrogen balance were measured during enteral nutrition support. Results: ①Compared with the control group, insulin resistance index(HOMA-IR) was significantly improved (P