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1.
Chinese Journal of Urology ; (12): 462-467, 2021.
Article in Chinese | WPRIM | ID: wpr-911050

ABSTRACT

Objective:To discover the clinical features of nocturnal enuresis (NE) in adults and to detect factors that correlated with the symptom severity.Methods:This cross-sectional study recruited NE subjects from September 2017 through December 2020. All patients had experienced enuresis at least once per week and with a symptom duration of 3 months or longer. Followed by documentation of history and medical records, three-day bladder diary was adopted to assess their voiding pattern, and urodynamic parameters were obtained to evaluate lower urinary tract function.Results:A total of 106 NE patients (43 male and 63 female) were identified. There is no statistical difference regarding the average age (men: 57.8±15.6 vs. women: 56.1±14.0, P>0.05) and BMI (men: 23.9±3.4 vs. women: 23.3±4.3, P>0.05) between men and women. Comorbidities are extremely common in NE patients (n=85, 80.2%), with the incidence rate higher in men compared to women [88.4% (38/43)vs. 74.6% (47/63), P<0.05]. Hypertension (n=58, 54.7%), hyperlipemia (n=41, 38.7%), diabetes mellitus (n=38, 35.8%), coronary heart disease (n=22, 20.8%) were the most frequently reported conditions. On bladder diaries, subjects were frequently manifested nocturnal polyuria (NP, 47/106, 44.3%), reduced nocturnal bladder capacity (NBC, 74/106, 69.8%), or combination of both(33/106, 31.3%). Urodynamic studies suggested that the incidence of reduce bladder compliance, detrusor overactivity (DO), stress incontinence, bladder outlet obstruction(BOO), detrusor underactivity(DU)and detrusor hyperreflexia with impaired contractility(DHIC)was 27.4%(29/106), 39.6%(42/106), 17.9%(19/106), 9.4%(10/106), 25.5%(27/106)and 15.1%(16/106), respectively. Women were more likely to suffer from stress urinary incontinence [2.3%(1/43) men vs. 28.6% (18/63) women, P<0.01], while men were prone to have bladder outlet obstruction [ 23.3%(10/43) men vs. 0 women, P<0.01]. Correlation analysis demonstrated that obesity( r=0.63, P<0.01), systemic comorbidities( r=0.40, P<0.01), presence of NP( r=0.50, P<0.01) and NP+ NBC( r=0.47, P<0.01), post-void residual( r=0.53, P<0.01), reduced compliance( r=0.21, P=0.04), DU( r=0.28, P<0.01), stress incontinence( r=0.42, P<0.01)and DHIC ( r=0.35, P<0.01)are positively correlated with NE severity. Whereas, reduced Q max( r=-0.35, P<0.01), low capacity( r=0.21, P=0.03), and reduced bladder sensation( r=-0.21, P=0.03) correlate negatively with NE severity. Conclusions:The presence of NE is not only a sign of bladder dysfunction, but also an implication of obesity, systematic chronic diseases, urine production malfunctioning. Therefore, a thorough history regarding the lower urinary tract function and systemic comorbidities should be taken carefully, so that, an integrated and personalized treatment can be carried out.

2.
Article in Chinese | WPRIM | ID: wpr-908491

ABSTRACT

Objective:To investigate the clinical characteristics and influencing factors of mortality in patients with intra-abdominal candidiasis (IAC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 203 IAC patients who were admitted to 7 medical centers from June 2018 to June 2020 were collected, including 54 cases in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, 31 cases in Fujian Medical University Union Hospital, 25 cases in Beijing Hospital, 25 cases in the First Affiliated Hospital of Xi'an Jiaotong University, 24 cases in China-Japan Friendship Hospital, 22 cases in General Hospital of Eastern Theater Command of Chinese PLA and 22 cases in Chongqing University Cancer Hospital. There were 130 males and 73 females, aged (64±15)years. Observation indicators: (1) candida infection and treatment of IAC patients; (2) analysis of influencing factors for mortality of IAC patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analyses were performed by Logistic regression model. Results:(1) Candida infection and treatment of IAC patients: 134 cases of candida albicans were cultured in the initial abdominal drainage fluid or intraoperative abdominal specimens of 203 patients, and 49 cases were treated with fluconazole. Of 69 cases infected with non candida albicans, 13 cases were treated with fluconazole. The resistance rate of candida albicans to fluconazole was 5.91%(12/203). Of 203 patients, there were 68 cases with infections shock, 53 cases with renal failure, 84 cases with respiratory failure and 63 cases with multiple organ failure, respectively. There were 148 of 203 patients admitted to intensive care unit for 9 days(range, 3-20 days), and the total hospital stay was 28 days(range, 17-50 days). Of 203 patients, 86 cases were cured and discharged, 50 cases were improved and transferred to local hospitals, 32 cases gave up treatment and discharged automatically, 19 cases died, 16 cases had no follow-up data. The mortality was 25.12%(51/203). (2) Analysis of influencing factors for mortality of IAC patients. Results of univariate analysis showed that acute physiology and chronic health evaluation score, sequential organ failure assessment score, the Cr, bilirubin, albumin, procalcitonin, and PLT on the first day of candida positive culture, of the lowest value in a week and the highest in a week, heart disease, diabetes, infections shock, renal failure, respiratory failure, multiple organ failure, anti-fungal therapy were the related factors for mortality of IAC patients ( t=-2.322, Z=-2.550, -2.262, -4.361, t=2.085, Z=-3.734, -5.226, -2.394, -5.542, t=3.462, Z=-4.957, -5.632, 3.670, -5.805, t=3.966, Z=-3.734, -5.727, χ2=4.071, 4.638, 27.353, 18.818, 13.199, 26.251, 13.388, P<0.05). Multivariate analysis showed that the bilirubin, procalcitonin on the first day of candida positive culture and infections shock were independent risk factors for mortality of IAC patients ( odds ratio=1.021, 1.022, 6.864, 95% confidence interval as 1.010-1.033, 1.001-1.044, 1.858-25.353, P<0.05). Conclusions:The common fungus of IAC was candida albicans, and fluconazole can be used as the initial empirical treatment. The prognosis of patients with abdominal candidiasis is poor. Bilirubin, procalcitonin on the first day of candida positive culture and infections shock are indepen-dent risk factors for mortality of IAC patients.

3.
Article in Chinese | WPRIM | ID: wpr-907924

ABSTRACT

Objective:To retrospectively analyze the clinical effects and complications of alcohol inactivation, irradiation inactivation, and liquid nitrogen inactivation in the treatment of femur osteosarcoma in children, in an attempt to provide a theoretical basis for clinical selection of in vitro inactivation methods of tumor bone segment. Methods:The clinical data of 93 children with femur osteosarcoma admitted to the Department of Bone and Soft Tissue, the Affi-liate Cancer Hospital of Zhengzhou University from January 2008 to December 2017 were retrospectively analyzed, and 40 children, including 21 males and 19 females, aged 8-18 (13.65±2.87) years, who were treated with in vitro inactivation and replantation of autogenous tumor bone segment, were screened.Among these children, there was alcohol inactivation in 15 cases, irradiation inactivation in 12 cases, and liquid nitrogen inactivation in 13 cases.A comparison was drawn on these 3 inactivation methods with respect to bone healing time, bone healing rate, tumor recurrence rate, infection rate, fracture or fixation failure rate, and revision rate. Results:All those 40 children were subject to valid medical followed-up, with the alcohol inactivation group for (102.60±16.55) months, the irradiation inactivation group for (59.33±6.39) months, and the liquid nitrogen inactivation for (36.85±6.49) months.The difference in follow-up time of 3 groups was statistically significant ( P<0.05). Compared with other 2 groups, the index of bone healing time, bone healing rate, infection rate and revision rate in the alcohol inactivation group were unfavorable, which showed a significant difference (all P<0.05); However, there was no significant difference in the recurrence rate, fracture rate or fixation failure rate compared with other 2 groups (all P>0.05); There was no significant difference in all above indexes between the irradiation group and the liquid nitrogen group (all P>0.05). Conclusions:Three in vitro inactivation methods for the treatment of tumor bone segment are safe and reliable.The alcohol inactivated bone has a long healing time and more complications.Both irradiation inactivation and liquid nitrogen inactivation are clinical options, but irradiation inactivation requires professional equipment, which may limit the clinical application.

5.
Chinese Journal of Urology ; (12): 815-819, 2020.
Article in Chinese | WPRIM | ID: wpr-869763

ABSTRACT

Objective:To evaluate the feasibility and effectiveness of sing-port robot-assisted laparoscopic radical prostatectomy(sp-RALP) through different approaches.Methods:The data of 115 patients who underwent sp-RALP through different approaches from May 2018 to June 2020 were retrospectively reviewed. In our study, 92 cases through extraperitoneal approach, 10 through transperineal approach and 13 though transvesical approach. Preoperative, intraoperative and early postoperative outcomes after various approaches were collected and analyzed. The mean age was 67(52-84) years, mean preoperative body mass index was 24.44(19.52-32.33) kg/m 2. Patients were graded as cT 1-3aN 0M 0 with no signs of regional lymph node invasion or distal metastasis. The median preoperative PSA was 9.77(6.54, 15.32) ng/ml. Results:All 115 sp-RALP were successfully completed with no conversion to open surgery or additional ports being placed. The mean operative time was 91.8(40-200)min, with 88.0(40-200)min for extraperitoneal approach, 132.5 (90-190)min for transperineal approach and 87.3(60-150)min for transvesical approach. The mean estimated blood loss was 85.5 (45-400)ml, with 77.6(50-200)ml for extraperitoneal approach, 178.0(80-400)ml for transperineal approach and 70.4 (45-150)ml for transvesical approach. Of the 115 patients, 60.9% (70/115)were <pT 3a, 39.1%(45/115) were ≥pT 3a. Positive margin(PSM) rate was 17.4%(20/115), with 31.1%(14/45) for ≥T 3a group, 8.6%(6/70) for <T 3a group. Postoperative pathology revealed a Gleason score of 3 + 3 in 6 patients, 3 + 4 in 45 patients, 4+ 3 in 52 patients, and ≥8 in 2 patients. Mean hospital stay was 3(1-7)d. Median postoperative PSA was 0.03(0.01, 0.05)ng/ml at 1 month postoperatively, and 88.7% patients reported less than 1 pad per day at 3 month postoperatively. Conclusions:With several advantages, such as better cosmesis, postoperative fewer pain, and better recovery as well as comparable oncological outcomes in the short-term follow-up, sp-RALP through various approaches is a feasible and effective procedure for organ-confined prostate cancer.

6.
Article in Chinese | WPRIM | ID: wpr-868655

ABSTRACT

Objective:To analyze the intensity-modulated radiotherapy (IMRT) process based on the TG100 report, aiming to improve the quality control method and guarantee the safety and quality of IMRT.Methods:Based on the TG100 report, a risk analysis team was established. The flow chart of overall and each sub-step of IMRT was constructed. The failure mode and effect analysis method were adopted to determine all potential error modes in the process. The probability of of the error mode, the probability of being checked out and the severity of the effect of the error mode on the clinical bed were evaluated based on the pre-set scoring standard. The priority value of each error mode was calculated and ranked from high to low priority value. The top 20% is defined as the high-risk error mode, which was analyzed by error tree to improve the quality control method.Results:IMRT consisted of 11 main steps and 41 sub-steps, and 180 failure modes were detected. The priority values were ranged from 30 to 178. A total of 36 high-risk failure modes were found. The top 5 high-risk failure modes (RPN) consisted of setup error (178), electronic portal imaging device (EPID) registration (172), contouring error (166), treatment delivery error (160) and prescription dose error (156).Conclusion:TG100 report is practical and convenient to utilize, which can effectively and systematically improve IMRT process and provide safety and quality assurance of IMRT process.

7.
Article in Chinese | WPRIM | ID: wpr-862516

ABSTRACT

Objective To study the needs, demands and utilization levels of health services for residents in Shenzhen, and to provide a basis for the rational allocation of health resources and formulation of relevant policies. Methods Using stratified random sampling, 6 072 residents from 2 365 households in 7 districts of Shenzhen were selected. The residents’ health status, health service demand and utilization were investigated by a questionnaire survey. The questionnaire survey response rate was 98.5%, and there was no significant difference between the sample and the population in age distribution (χ2=5.60,P=0.47). Results The average score of self-health assessment was 84.9. The prevalence rate of chronic diseases was 21.1%. The two-week disease prevalence rate was 21.5%, and the doctor visit rate of the two-week disease was 19.5%. The hospitalization rate was 7.2% in the past year. The average outpatient cost was 500 yuan, and the average cost of hospitalization was 10 567 yuan. The average length of hospital stay was 7.3 days. A total of 652 (55%) patients had their first outpatient visit at the community health service centers, and 82.2% of the families were within 1 kilometer from the nearest medical institutions. Conclusion Compared with that of the national population, the overall health service needs of Shenzhen residents were relatively low, but there is a problem that the hospitalization demand has not been effectively released. The prevention and treatment of chronic diseases such as diabetes and hypertension should not be ignored, and the construction of the public health system needs to be strengthened. The "health gatekeeper" system has initially taken shape, but the residents' sense of acquisition needs to be further improved.

8.
Article in Chinese | WPRIM | ID: wpr-756395

ABSTRACT

Objective To summarize the clinical experience of artificial vascular sleeve-like inverted suture in proximal part of ascending aorta, and to explore the effectiveness of the method. Methods A retrospective study was performed. From August 2017 to April 2018, 10 patients with Stanford type A aortic dissection with surgical indications for ascending aortic re-placement were treated with artificial vascular sleeve-like inverted suture for proximal part of ascending aorta, 9 cases of emer-gency operation, 8 cases of males and 2 females, aged 43-69 years, mean(51 ± 6) years old. The specific method for opera-tion is to invert the artificial blood vessel 2 cm outward and then insert it into the ascending aorta, suture the inverted part of the artificial blood vessel and the ascending aorta continuously. If there is obvious bleeding, stitch strips made of artificial blood vessel or pericardium with theanastomosis ring. The drainage in 24 hours after operation and early postoperative outcome were observed. Results There was no intraoperative death in the whole group, and there was no second thoracotomy for hemostasis. The drainage volume was 150-880 ml, average(260 ± 55) ml in 24 hours after surgery. One patient developed gastrointestinal hemorrhage after operation, and healed after two times of hemostasis by bedside gastroscopy. Two patients had transient neuro-logical dysfunction( TND) . All of the 10 patients were cured and discharged after treatment. All patients were followed up for 1-6 months. All patients underwent transthoracic echocardiography. Eight of them underwent CT angiography, no new aortic regurgitation, and no obvious sinus widening. Conclusion The artificial blood vessel sleeve-like inverted suture is a simple and reliable operation in reinforcement for proximal part of ascending aorta. The anastomosis circle and the suture pinprick are not directly in contact with the blood flow, reducing the chance of bleeding. Even if there is tinybleeding, it will be easy to find and repair. In conclusion, this method is convenient and effective, and it is worthy of clinical promotion.

9.
Journal of Chinese Physician ; (12): 661-664, 2019.
Article in Chinese | WPRIM | ID: wpr-754205

ABSTRACT

Trauma,iatrogenic injury,and neurological disorders can lead to neurogenic lower urinary tract dysfunction (NLUTD).However,there are some special causes in women,including radical hysterectomy,mid-urethral suspension,pelvic organ prolapse repair,Fowler syndrome,interstitial cystitis etc.Traditional behavioral therapy,drug treatment and surgeries may work less well in patients with NLUTD and may even lead to progression and deterioration of the diseases.A review of current literatures revealed that there is an increasing evidence on the application of sacral neuromodulation (SNM) in the treatment of NLUTD in female.This review will provide a summary of the known mechanisms of female NLUTD and the effectiveness of SNM.

10.
Article in Chinese | WPRIM | ID: wpr-752916

ABSTRACT

Objective To explore the value of amplitude integrated electroencephalography (aEEG) in cerebral function monitoring in preterm infants younger than 30 weeks of gestation. Methods A total of 165 cases of preterm infants younger than 30 weeks of gestation were prospectively enrolled in the study from September 2015 to February 2017,including 20 preterm infants with severe brain injury ( severe brain injury group) and 145 with non-severe brain injury ( non-severe brain injury group). Five aspects of each tracing, such as continuity(Co),sleep-wake cycling( Cy),amplitude of the lower border(LB),bandwidth( B) and total maturation scores,were evaluated and compared between two groups by applying a preterm infants aEEG scoring system. The neuromotor development of preterm infants survivors was assessed by using the 0 to 6 years old children′s neurological and psychological development scale of China Capital Institute of Pediatrics. Clinical data were collected and compared with the results of aEEG. Results The scores for Co,Cy,LB,B as well as total maturation scores of preterm infants with severe brain injury at different gestational age were lower than those of infants with non-severe brain injury at the same gestational age. The differences were sta-tistically significant (all P<0. 05). There were no statistical differences in Co,Cy,LB,B scores and total maturation scores between each gestational ages in severe brain injury group (all P>0. 05). Scores for Co, Cy,B and total maturation scores progressively increased with advancing gestational age in non-severe brain injury group( all P <0. 05),but there were no statistical differences between each gestational ages in LB scores(all P>0. 05). Follow-up results of 16 cases with severe brain injury:15 cases of DQ≤69,1 case of DQ 70-84,and no cases of DQ≥85; 130 cases of non-severe brain injury group:78 case of DQ≥85,42 cases of DQ 70-84,10 cases of DQ≤69. By chi-square analysis and Spearman rank correlation analysis,the results of aEEG total maturation scores were correlated with outcome of these preterm infants younger than 30 weeks of gestation ( r =0. 702,P <0. 05). Conclusion aEEG can provide important information of the status of cerebral function in preterm infants younger than 30 weeks of gestation and help to predict their outcome.

11.
Article in Chinese | WPRIM | ID: wpr-801359

ABSTRACT

Objective@#To evaluate the mid- and long-term efficacy of Hybrid coronary revascularization (HCR) in the treatment of multi-vessel coronary artery disease for 5 years after operation, and to compare the operative effect with those of off-pump coronary artery bypass grafting (OPCABG) for the same period.@*Methods@#From March 2010 to June 2013, 37 patients underwent selective staging HCR surgery (HCR group) due to multi-vessel coronary artery disease in our hospital. All patients were treated by PCI and MIDCAB subsequently. 148 patients with OPCABG completed by the same group of doctors at the same time were served as control group (OPCABG group), and the follow-up period was up to June 2018. The end point of the study was the incidence of major adverse cardiac or cerebrovascular events (MACCE) events in both groups, including cardiac death, new myocardial infarction, secondary coronary revascularization and cerebrovascular accident.@*Results@#The clinical baseline data of the two groups were basically matched. 37 patients in HCR group were successfully operated on, and each patient was completed with LIMA-LAD bypass, 72 drug-eluting stents were implanted. 504 stents were bridged in 148 patients in OPCABG group, each patient was completed with LIMA-LAD bypass, the other target vessels were performed by sequential anastomosis with great saphenous vein as graft. The average follow-up time was 6.3 years (5.1-8.2 years). In HCR group, 33 patients(89%)completed the follow-up, of which 6 (18%) had MACCE events. In OPCABG group, 130 patients(88%)successfully completed the follow-up, of which 19 (15%) had MACCE events. There was no significant difference in MACCE-free survival rate between the two groups (HCR 81.8% vs. OPCABG 73.8%, P>0.05).@*Conclusion@#The mid- and long-term effect of HCR is similar to that of OPCABG in the treatment of multi-vessel coronary artery disease, but it has the advantages of less traumatic, faster recovery and less use of blood products. It can be widely used in patients with selective multi-vessel coronary artery disease.

12.
Article in Chinese | WPRIM | ID: wpr-800802

ABSTRACT

Objective@#To investigate the effects of simulated-thermobaric explosive gas on the respiration and nervous system in rats.@*Methods@#70 of SPF SD rats were randomly divided into four thermobaric explosive gas groups, two restoration observation groups and control group from April to August in 2018. The exposure time of in four thermobaric explosive gas groups were 3.75, 7.5, 15.0 and 30 min, respectively. The restoration observation groups were designed to observe for 30 and 120 min after exposure thermobaric explosive gas 30 min. The bloods were collected and analyzed at the end of exposure and recovery observation. The endogenous carbon monoxide (CO) , nitric oxide (NO) , glutamic acid (GLU) , acetylcholinesterase (AchE) and dopamine (DA) were detected in brain tissues, respectively.@*Results@#The blood gas index (pH, PCO2, PO2, COHb, O2Hb, MeHbt) and blood electrolytes (Na+, K+, Ca2+ and Cl-) in exposure groups have significant differences with these in control (P<0.05) . The pH value decreased with the exposure time longer. However, it basically returned to normal level when terminating exposure for 120 min. The concentration of PCO2, MeHb and CoHb increased first and then decreased with the exposure time extension. Conversely, The PO2 and O2Hb decreased first and then increased with the exposure time longer. The concentration of endogenous CO, GLU, and AchE decreased and NO increased in exposure group 4 and the restoration observation group 1 compared with those in control (P<0.01) . In addition, there were pathological changes in lung and brain tissue of exposure group, such as inflammatory cell infiltration and edema.@*Conclusion@#The blood gas index, electrolytes, neurotransmitter, histopathology of lung and brain were changed to various degrees by thermobaric bomb gas exposure. These findings would provide some beneficial support for evaluating the damage effect of thermobaric bomb gas on organisms.

13.
Article in Chinese | WPRIM | ID: wpr-797971

ABSTRACT

Objective@#To summarize the clinical experience of artificial vascular sleeve-like inverted suture in proximal part of ascending aorta, and to explore the effectiveness of the method.@*Methods@#A retrospective study was performed. From August 2017 to April 2018, 10 patients with Stanford type A aortic dissection with surgical indications for ascending aortic replacement were treated with artificial vascular sleeve-like inverted suture for proximal part of ascending aorta, 9 cases of emergency operation, 8 cases of males and 2 females, aged 43-69 years, mean(51±6) years old. The specific method for operation is to invert the artificial blood vessel 2 cm outward and then insert it into the ascending aorta, suture the inverted part of the artificial blood vessel and the ascending aorta continuously. If there is obvious bleeding, stitch strips made of artificial blood vessel or pericardium with theanastomosis ring. The drainage in 24 hours after operation and early postoperative outcome were observed.@*Results@#There was no intraoperative death in the whole group, and there was no second thoracotomy for hemostasis. The drainage volume was 150-880 ml, average(260±55) ml in 24 hours after surgery. One patient developed gastrointestinal hemorrhage after operation, and healed after two times of hemostasis by bedside gastroscopy. Two patients had transient neurological dysfunction(TND). All of the 10 patients were cured and discharged after treatment. All patients were followed up for 1-6 months. All patients underwent transthoracic echocardiography. Eight of them underwent CT angiography, no new aortic regurgitation, and no obvious sinus widening.@*Conclusion@#The artificial blood vessel sleeve-like inverted suture is a simple and reliable operation in reinforcement for proximal part of ascending aorta. The anastomosis circle and the suture pinprick are not directly in contact with the blood flow, reducing the chance of bleeding. Even if there is tinybleeding, it will be easy to find and repair. In conclusion, this method is convenient and effective, and it is worthy of clinical promotion.

14.
International Journal of Surgery ; (12): 717-720, 2019.
Article in Chinese | WPRIM | ID: wpr-797197

ABSTRACT

Severe acute pancreatitis is a common clinical acute abdominal disease, characterized by acute onset, rapid progression, high risk, poor prognosis and so on. Due to the high mortality of this disease, it has been the focus and difficulty of clinical research. The traditional treatment of severe acute pancreatitis mainly include fasting and parenteral nutrition. However, recently, international and national consensus suggest that early enteral nutrition is fit for severe acute pancreatitis, although the timing of early enteral nutrition has been controversial. The article summarizes the optimal timing of early enteral nutrition for severe acute pancreatitis.

15.
International Journal of Surgery ; (12): 717-720, 2019.
Article in Chinese | WPRIM | ID: wpr-789142

ABSTRACT

Severe acute pancreatitis is a common clinical acute abdominal disease,characterized by acute onset,rapid progression,high risk,poor prognosis and so on.Due to the high mortality of this disease,it has been the focus and difficulty of clinical research.The traditional treatment of severe acute pancreatitis mainly include fasting and parenteral nutrition.However,recently,international and national consensus suggest that eady enteral nutrition is fit for severe acute pancreatitis,although the timing of early enteral nutrition has been controversial.The article summarizes the optimal timing of early enteral nutrition for severe acute pancreatitis.

16.
Article in Chinese | WPRIM | ID: wpr-824873

ABSTRACT

Objective To evaluate the mid-and long-term efficacy of Hybrid coronary revascularization (HCR) in the treatment of multi-vessel coronary artery disease for 5 years after operation,and to compare the operative effect with those of offpump coronary artery bypass grafting (OPCABG) for the same period.Methods From March 2010 to June 2013,37 patients underwent selective staging HCR surgery (HCR group) due to multi-vessel coronary artery disease in our hospital.All patients were treated by PCI and MIDCAB subsequently.148 patients with OPCABG completed by the same group of doctors at the same time were served as control group (OPCABG group),and the follow-up period was up to June 2018.The end point of the study was the incidence of major adverse cardiac or cerebrovascular events (MACCE) events in both groups,including cardiac death,new myocardial infarction,secondary coronary revascularization and cerebrovascular accident.Results The clinical baseline data of the two groups were basically matched.37 patients in HCR group were successfully operated on,and each patient was completed with LIMA-LAD bypass,72 drug-eluting stents were implanted.504 stents were bridged in 148 patients in OPCABG group,each patient was completed with LIMA-LAD bypass,the other target vessels were performed by sequential anastomosis with great saphenous vein as graft.The average follow-up time was 6.3 years (5.1-8.2 years).In HCR group,33 patients(89%)completed the follow-up,of which 6 (18%) had MACCE events.In OPCABG group,130 patients(88%)successfully completed the follow-up,of which 19 (15%) had MACCE events.There was no significant difference in MACCE-free survival rate between the two groups (HCR 81.8% vs.OPCABG 73.8%,P > 0.05).Conclusion The mid-and long-term effect of HCR is similar to that of OPCABG in the treatment of multi-vessel coronary artery disease,but it has the advantages of less traumatic,faster recovery and less use of blood products.It can be widely used in patients with selective multi-vessel coronary artery disease.

17.
Chinese Critical Care Medicine ; (12): 658-661, 2018.
Article in Chinese | WPRIM | ID: wpr-806816

ABSTRACT

Objective@#To explore the correlation between thromboelastography (TEG) parameters and the risk of venous thromboembolism (VTE) and bleeding in patients receiving anticoagulant therapy in surgical intensive care unit (SICU).@*Methods@#205 patients received low molecular weight heparin (LMWH) anticoagulant therapy admitted to SICU of Tianjin Hospital from December 2016 to December 2017 were consecutively enrolled. TEG detection was performed in all patients at 1 day after anticoagulation therapy, and coagulation reaction time (R value), blood clot generation time (K value), blood clot generation rate (α angle) and maximum width value (MA value) were recorded. At the same time, the traditional coagulation function test was carried out, and prothrombin time (PT), activated partial thromboplastin time (APTT) and D-dimer levels were also recorded. The incidence of deep venous thrombosis (DVT), pulmonary embolism (PE) and bleeding during hospitalization were observed. Multivariate Logistic regression analysis was used to analyze the risk factors for VTE and bleeding in patients receiving anticoagulant therapy.@*Results@#Of 205 patients, during the anticoagulant treatment, 14 patients developed DVT, and 4 patients with PE (2 of them were combined with DVT) with an incidence of 7.8% (16/205). There were 2 patients suffering from cerebral hemorrhage, 2 patients with gastric bleeding, and 1 patient with intra-tracheal hemorrhage with an incidence of 2.4% (5/205). Compared with the patients without VTE or bleeding, the R value of TEG in patients with VTE was significantly lowered (minutes: 4.6±2.2 vs. 7.4±1.4, P < 0.01), which was significantly increased in patients with hemorrhagic complications (minutes: 12.1±1.1 vs. 7.4±1.4, P < 0.01). There was no significant difference in the K value, α angle, MA value of TEG, or PT, APTT, D-dimer between the patients with and without VTE or bleeding. Multivariate Logistic regression analysis revealed that the R value of TEG was independent risk factor for incidence of VTE and hemorrhagic complication in SICU patients who receiving anticoagulation therapy [VTE: β = 0.386, odds ratio (OR) = 1.096, 95% confidence interval (95%CI) = 1.021-2.361, P = 0.006; hemorrhagic complication: β = -1.213, OR = 1.051, 95%CI = 1.017-3.458, P = 0.045].@*Conclusion@#The R value of TEG is associated with the occurrence of VTE and hemorrhagic complications in patients receiving anticoagulant therapy in SICU.

18.
Chinese Journal of Lung Cancer ; (12): 779-783, 2018.
Article in Chinese | WPRIM | ID: wpr-772365

ABSTRACT

BACKGROUND@#Pulmonary thrombosis embolism (PTE) is one of the most severe complications of perioperative radical mastectomy. Massive PTE is often accompanied by shock and hypotension which is characterized by rapid progression and high mortality. There is no standard for the treatment of these patients, which is thoracic surgery, and it is a critical issue in the thoracic surgeons. This article summarizes and analyzes the treatment of two patients with high-risk PTE at the early stage of postoperative lung cancer in our hospital. In addition, we discusses the diagnosis and treatment strategies of these cases to provide a reference for the thoracic surgeons.@*METHODS@#We presented two patients with high-risk PTE at the early stage after thoracic surgery for radical surgery in our hospital back in 2017. One case was treated with intravenous venous interventional thrombolysis, and the other was treated with thrombolysis alone. The treatment effect of two patients and the complications during the treatment has been recorded to detail and summarized.@*RESULTS@#Both patients were female who aged 66 and 61 years old. The time point of pulmonary embolism was 48 h and 45 h after operation, and the time of interventional thrombolysis was 70 minutes and 50 minutes after onset respectively. After 120 minutes and 100 minutes, the drainage after interventional thrombolysis was 4,690 mL and 520 mL respectively. The hospitalization time after thrombolysis was 21 days and 14 days respectively. There was no obvious complication through a follow-up of 6 months.@*CONCLUSIONS@#Early postoperative acute massive pulmonary embolism in lung cancer should be treated with pulmonary interventional thrombolysis as soon as possible. Compared with intravenous thrombolysis, pulmonary interventional thrombolysis shows accuracy, easy controlling of dosage, fast curative effect and low bleeding risk.


Subject(s)
Female , Humans , Lung Neoplasms , General Surgery , Middle Aged , Postoperative Complications , Therapeutics , Pulmonary Embolism , Therapeutics , Retrospective Studies , Thoracic Surgery, Video-Assisted , Thrombolytic Therapy
19.
Herald of Medicine ; (12): 16-19, 2018.
Article in Chinese | WPRIM | ID: wpr-665262

ABSTRACT

Objective To observe the effects of total glucosides of white paeony(GWP) on psychological ethology and neuroendocrine system of stress rats. Methods Ten male Sprague-Dawley rats were treated as normal control group,the others (n=40) were constructed by isolated custody and chronic unpredictable stimuli to build the model of stress rats.Stress rats were randomly divided into 4 groups:model control group,GWP high dose group and low dose(66,33 mg·kg-1) group,fluoxetine(5. 0 mg·kg-1) group,each group had 10 rats.The changes of rat behavior were monitored by locomotor activity system.The change of emotion was observed by tail suspension test.The pathology change of adrenal was observed by HE staining.The levels of CorT and ACTH in serum were measured by radioimmunoassay.The expression of CRH mRNA of hypothalamic were detected by RT-PCR. Results The activity of the level scoring and vertical scoring of GWP high dose group was obviously improved as compared to that in model control group,while static time was significantly shortened,Adrenal index of GWP groups were increased significantly(P<0.05),thymus index of the treatment group was declined(P<0.05),CorT and ACTH content were decreased (P<0.05) and hypothalamus CRH mRNA of GWP group was decreased(P<0.05). Conclusion The improvement of activity and related hormone anomalous changes were observed in rats treated with GWP.The mechanism of its actions might be involved adjusting the endocrine function,decreasing CorT and ACTH content and the expression of hypothalamic CRH mRNA of stress rats.

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Chinese Journal of Microsurgery ; (6): 464-468, 2018.
Article in Chinese | WPRIM | ID: wpr-711687

ABSTRACT

Objective To investigate the clinical effect of using pedicled flap to reconstruct skin and soft tis-sue defect after resection of sarcoma around extremities joint. Methods Retrospectively analysis 103 cases of sar-coma around extremities joint who was treated from June, 2012 to June, 2017 and used the pedicled fasciocutaneous flaps or pedicled musculocutaneous flaps to reconstruct the defect after sarcoma resection. There were 61 males and 42 females, with a mean age of 52.3 (14-82 ) years old. Among these patients, there were 32 initial diagnosis, 30 had been resected in other units, and 41 recurrent tumor. There were 13 patients that tumor around wrist:reconstructed by radial wrist upper branch fasciocutaneous flap, dorso-ulnar flap based on supracarpal perforator, and posterior in-terosseous artery flap. Eight patients with tumor around elbow: reconstructed by lateral arm flap and media arm flap. Eight patients with tumor around shoulder: reconstructed by latissimus dorsi musculocutaneous flap and lateral tho-racic flap. Fourteen patients with tumor around hip: rectus femoris musculocutaneous flap, tensor fascia lata musculo-cutaneous flap, and posterior thigh fasciocutaneous flap. Sixteen patients that tumor around knee:reconstructed by an-terolateral low leg flap, and sural calf fasciocutaneous flap. Forty-four patients that tumor around ankle: reconstructed by saphenous neuro-veno-fasciocutaneous flap, sural neuro-veno-fasciocutaneous flap, lateral supramalleolar flap, and medial plantar flap. The defect area after tumor resection were:3 cm ×4 cm-18 cm×25 cm. After surgery, observe the situation and fitness of flap, complication, joint mobility, and tumor recurrence and metastasis. Results Allflaps survived except 6 died or partial died, with a survival rate of 94.2%, of which dead flap were replaced by a new flap or covered by free skin graft. Infection occurred in 4 cases (2 in donor site and 2 in recipient site), were cured by dressing and antibiotic. Except for 12 cases dropped, all rest 91 cases were followed-up by 33 months on average (1-5 years), flaps' shape and texture were good, without swollen and fester, and fit well. Superficial sensibility of direct fasciocuta-neous flaps and musculocutaneous flaps were normal, protective sensation of reverse fascial flaps were recovered. The mobility of affected joint show no difference compared with the other side. No ulcer occurred on flaps of plantar and but-tocks, that helps normal sit position and gait. There were 17 recurrences and 32 metastasis occurred, 21 patients died so far. There was a statistical difference between recurrent cases with first shot(10.3%) second widely resection(11.5%) and recurrent resection(30.6%)(P<0.05). Conclusion Using pedicled flap to reconstruct skin defect after the resection of sarcoma around extremities joint, can get good clinical result, with simple and reliable operation. It is worth to popularize.

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