Application of recovery autologous blood transfusion combined with bilateral internal iliac artery presetting in high-risk patients with hemorrhage during cesarean section / 中国输血杂志

【Objective】 To explore the effect of recovery autologous blood transfusion combined with bilateral internal iliac artery presetting in high-risk patients with hemorrhage during cesarean section. 【Methods】 A total of 162 high-risk patients with hemorrhage who underwent cesarean section from January 2021 to May 2023 in our hospital were prospectively selected and divided into in Groups A, B, and C with 54 cases in each group according to the indications for the method of transfusion. Group A received allogeneic blood transfusion, Group B received autologous blood transfusion, Group C received autologous blood transfusion combined with bilateral internal iliac artery balloon presetting. 【Results】 Intraoperative blood loss (mL) (1 600 vs 1 500 vs 800), postoperative hospital stay(d) (7 vs 7 vs 6) and operative time(min) (107 vs 104.50 vs 77) in group C were all lower than those in group A and B (P0.05); The autologous blood transfusion volume(mL) in group C was lower than that in group B (525.5 vs 261, P0.016 7). 【Conclusion】 Recovery autologous blood transfusion combined with bilateral internal iliac artery balloon presetting in cesarean section for high-risk patients with hemorrhage achieved ideal effects, which can significantly reduce intraoperative blood loss, intraoperative autologous blood transfusion, allogeneic red blood cells and plasma transfusion, as well as the operation time and postoperative hospital stay. In addition, it can improve the coagulation function and hysterectomy, which is conducive to ensuring the safety of maternal and promoting early rehabilitation, and preserving the fertility of patients to a certain extent, which is worthy of further clinical promotion.

Efficacy of short-term moderate or high-dose statin therapy for the prevention of contrast-induced nephropathy in high-risk patients with chronic kidney disease: systematic review and meta-analysis

Although previous studies have indicated that statin therapy can effectively prevent the development of CIN, this observation remains controversial, especially in high-risk patients. A meta-analysis was performed to evaluate the efficacy of statin pretreatment for preventing the development of CIN in patients with chronic kidney disease (CKD) and to determine its effectiveness in various subgroups. We searched the online databases PubMed, EMBASE, and the Cochrane Library. RCTs that involved the comparison of the short-term moderate or high-dose statin pretreatment with placebo for CIN prevention in CKD patients undergoing angiography were included. The primary outcome was CIN prevalence. Seven RCTs comprising 4256 participants were investigated in this analysis. The risk of developing CIN in patients pretreated with statins was significantly lower than that in patients pretreated with placebo (RR=0.57, 95%CI=0.43-0.76, p=0.000). The SCr values of the statin group, when analyzed 48h after angiography were lower than those of the placebo group ((SMD=-0.15, 95% CI=-0.27 to -0.04, p=0.011). In the subgroup analysis, statin pretreatment could decrease the risk of CIN in CKD patients with DM (RR=0.54, 95% CI=0.39-0.76, p=0.000), but not in CKD patients without DM (RR=0.84, 95% CI=0.44-1.60, p=0.606). The efficacy of atorvastatin for preventing CIN was consistent with that observed with the use of rosuvastatin. The risk ratios (RR) were 0.51 (95% CI=0.32-0.81, p=0.004) and 0.60 (95% CI=0.41-0.88, p=0.009), respectively. Our study demonstrated that statin pretreatment could prevent the development of CIN in CKD patients. However, subgroup analysis demonstrated that statin pretreatment, despite being effective in preventing CIN in patients with CKD and DM, was not helpful for CKD patients without DM. Rosuvastatin and atorvastatin exhibited similar preventive effects with respect to CIN.

Recurrent diabetic ketoacidosis

ABSTRACT Objective The purpose of this study is to examine risk factors for recurrence of diabetic ketoacidosis and determine interventions to prevent future admissions. Materials and methods Review article. Results Recurrent diabetic ketoacidosis is a serious and not uncommon health problem. Diabetic ketoacidosis is associated with severe morbidity and mortality and hospital admissions due to this problem constitute a serious economic burden on the healthcare system. Younger age at diabetic ketoacidosis onset, poor baseline glycemic control and elevated HbA1C, patient comorbidities, depression, alcohol or substance abuse, particularly active cocaine use, have been associated with recurrent diabetic ketoacidosis. In addition, socioeconomic factors (such as ethnic minority status, use of public health insurance and underinsurance), psychosocial, economic, and behavioral factors (including financial constraint, stretching a limited insulin supply, and homelessness) have been all reported to be associated with readmission among diabetic ketoacidosis patients. Conclusions Identifying high-risk patients during the first diabetic ketoacidosis admission and performing relevant interventions (repeated instructions of insulin use, social help and involvement of family members in medical treatment, collaboration with the patient's primary care physician in order to establish a close and frequent follow up program) may help prevent future admissions. Further studies need to take place to determine whether early interventions with those factors prevent future admissions.

Effects of cardiac rehabilitation combined with psychological invention on clinical efficacy in high-risk patients with acute myocardial infarction after emergent percutaneous coronary intervention / 中华行为医学与脑科学杂志

Objective@#To investigate the effects of stage I cardiac rehabilitation combined with structural psychological invention high-risk patients with acute myocardial infarction (AMI) treated by emergent percutaneous coronary intervention (PCI).@*Methods@#Totally 120 patients with AMI that received emergent PCI were randomized into experimental group(n=60) and control group(n=60). The experimental group started stage I cardiac rehabilitation combined with structural psychological invention after emergency PCI.The control group received routine treatment.Self-rating Anxiety Scale (SAS) and Self-rating depression Scale (SDS) scores were compared in both groups at before PCI and 1 week after PCI.Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were compared in both groups at before PCI and 1 week, 1 month and 6 months after PCI.The incidence of adverse cardiac events including cardiac death and recurrence myocardial infarction were compared between the two groups at 6 months after PCI.@*Results@#The SAS score in the experimental group (36.38±5.15) was lower than that in the control group (42.10±5.79) in 1 week after PCI (t=2.313, P<0.05). The SDS score in the experimental group(37.09±5.56) was lower than that in the control group (43.85±5.33) in 1 week after PCI (t=2.330, P<0.05). The LVEF in the experimental group( (45.08±4.41)%) was significantly higher than that in the control group ((42.81±3.83)%) in 1 week after PCI ( t=2.209, P<0.05). The LVEF in the experimental group ((48.93±4.39)%) was significantly higher than that in the control group ((44.61±4.35)%) in 1 month after PCI (t=2.224, P<0.05). The LVEDD in the experimental group ((54.74±4.01)mm) was significantly lower than that in the control group ((57.81±4.49)mm) in 1 month after PCI (t=2.413, P<0.05). The LVEDD in the experimental group ((52.21±2.82)mm) was significantly lower than that in the control group ((55.65±3.88)mm) in 6 month after PCI (t=2.297, P<0.05). And there were no significant difference between the two groups at other time point(all P>0.05). The follow-up results after 6 months showed that the experimental group (8.9%) had lower incidence of cardiac death than that in the control group (24.1%) (HR(95%CI): 0.317(0.128-0.835), P<0.05). The follow-up results after 6 months showed that the experimental group (14.2%) had lower incidence of recurrence myocardial infarction than that in the control group (42.2%) (HR(95%CI): 0.263(0.125-0.548), P<0.05).@*Conclusion@#Stage I cardiac rehabilitation improved the cardiac function in high-risk patients with AMI treated by emergent PCI and reduced the incidence of cardiac death and recurrence myocardial infarction.

The role of polysaccharide peptide of Ganoderma lucidum as a potent antioxidant against atherosclerosis in high risk and stable angina patients

Objectives Antioxidants can reduce oxidative radicals that affect the early phase of atherogenesis, that is endothelial dysfunction. Polysaccharide Peptide (PsP) derived from Ganoderma lucidum has an active substance in the form of β-glucan. Previous studies have proven the PsP of Ganoderma lucidum as an effective antioxidant in atherosclerotic rats and shows no toxicity in animal model. This study aims to prove the effect of PsP as potent antioxidant in high risk and stable angina patients. Method This is a clinical trial conducted to 37 high risk and 34 stable angina patients, which were determined based on ESC Stable CAD Guidelines and Framingham risk score, with pre and post test design without control group. The parameters are superoxide dimustase (SOD) and malondialdehyde (MDA) concentration, circulating endothelial cell (CEC) and endothelial progenitor cell (EPC) counts. The patients were given PsP 750 mg/day in 3 divided dose for 90 days. Paired t-test was performed for normally distributed data, and Wilcoxon test for not normally distributed data, and significant level of p ≤ 0,05. Results SOD level in high risk patients slightly increased but not statistically significant with p = 0,22. Level of SOD in stable angina group significantly increased with p = 0,001. MDA concentration significantly reduced in high risk and stable angina patients with p = 0.000. CEC significantly reduced both in high risk and stable angina patients, with p = 0.000 in both groups. EPC count significantly reduced in high risk and stable angina with p = 0.000. Conclusion PsP of Ganoderma lucidum is a potent antioxidant against pathogenesis of atherosclerosis in stable angina and high risk patients

Transurethral columnar balloon dilation of prostate for benign prostatic hyperplasia in middle-aged and high-risk patients / 重庆医学

Objective To analyze and summarize the short-term clinical efficacy and surgical points of transurethral columnar balloon dilation of prostate for middle-aged and high-risk prostatic hyperplasia patients.Methods A total of 30 patients with benign prostatic hyperplasia(BPH) admitted to our department from March 2016 to December 2016 was retrospectively analyzed,including 9 middle-aged patients(less than 60 years old) and 21 high-risk patients with various underlying diseases(more than 80 years old).Transurethral columnar balloon dilation of prostate was adopted and performed in accordance with standard operation process.Results All 30 patients were operated successfully by extending their prostate at the direction of 12 o'clock to the fat layer with short operation time and less amount of bleeding.The complication rate was 6.7％ (2/30),and the catheter was removed smoothly after the operation.After 1 month and 6 months follow-up,the international prostate symptom score(IPSS),quality of life score(QOL),maximum urinary flow rate(Qmax),residual urine(RUV) and other indicators were analyzed and were statistically significant(P＜0.05).Conclusion Transurethral columnar balloon dilation of prostate is an effective and supplemental method for the treatment of BPH in middle-aged and high-risk patients.

Pancreatic duct stent preventing post endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients / 第二军医大学学报

Objective To evaluate the preventive effect of pancreatic duct stent against post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and hyperamylasemia in high-risk patients. Methods A total of 160 patients with high-risk PEP underwent ERCP therapy between Jan. 2013 and Dec. 2014 and were retrospectively analyzed. The patients were divided into pancreatic duct stent group (n =82) and-control group (n=78) according to whether receiving pancreatic duct stent or not. Abdominal pain was evaluated after ERCP. The levels of serum amylase were detected at 3 h and 24 h after ERCP. The incidences of PEP and hyperamylasemia were compared between the two groups. Results The serum amylase levels at 3 h and 24 h after ERCP in pancreatic duct stent group were significantly lower than those in control group ([184. 89±257. 33] U/L vs [305. 35±371. 81] U/L, P<0. 05; [268. 07±344. 73] U/L vs [465. 86±639. 94] U/L, P< 0. 05). The incidences of PEP and hyperamylasemia in pancreatic duct stent group were also significantly lower than those in control group (2. 4% [2/82] vs 11. 5% [9/78], P<0. 05; 17. 1% [14/82] vs 30. 8% [24/78], P<0. 05). The incidence of abdominal pain and abdominal pain score were (19. 5% [16/82], [1. 24 + 0. 58]) in pancreatic duct stent group, which were significantly lower than those in control group (43. 6% [34/78], [1. 68±0. 97]) (P = 0. 001). Conclusion Pancreatic duct stent can effectively prevent PEP and hyperamylasemia in high-risk patients following ERCP.

Surveillance and early diagnosis of small hepatocellular carcinoma with contrast-enhanced ultrasonography / 中国癌症杂志

Background and purpose:The incidence of liver cancer is high in China. Primary liver cancers usually occur in patients with liver cirrhosis, which is a challenge for the early diagnosis of liver cancer. Our purpose is to investigate the efifcacy of contrast-enhanced ultrasonography (CEUS) in the early identiifcation and diagnosis of small hepatocellular carcinoma (HCC) by regularly tracking and supervising the high risk population. Methods:A total of 320 high risk patients of HCC admitted in our hospital from February 2011 to November 2013 were enrolled in this prospective study. All patients underwent conventional ultrasound and hepatic CEUS. The differential diagnosis of malignant HCCs from benign ones was based on the enhancement patterns of hepatic lesions in different phases on CEUS. Results:Twenty patients were diagnosed as small HCC among 320 HCC high risk patients who were under regular surveillance using CEUS and all were pathologically conifrmed. Seven of the 20 HCC cases were smaller than 1.0 cm and 13 measured 1.1-2.0 cm. There were 6 (30.0%) HCCs presented as“early wash-in and slow wash-out”atypical pattern of HCC. The small size of the lesion and iso-echogenicity were the main factors of atypical pattern of HCC on CEUS.Conclusion:Ultrasonography and CEUS surveillance is a useful strategy for the early detection of small HCCs in high risk patients, which can help them to receive proper therapeutic management in time.

Synchronous primary cancers of the head and neck region and upper aero digestive tract: Defining high-risk patients

Background: Patients with cancers in the head and region are at increased risk of developing synchronous primary cancers. Aim: To see the epidemiology of synchronous cancers of the head and region and identification of high-risk factors for the development of synchronous primary in the head and neck cancers. Materials and Methods: Data of head and neck cancer patients from January 2010 to December 2011 were obtained from the hospital cancer registry for retrospective analysis of patients with synchronous cancers. All synchronous malignancies were analyzed for distribution of sites, association with smoking history, stage of index head, and neck tumor and the average age of patients at presentation with synchronous cancers. The Chi-square test for association of upper aero digestive tract (UADT) and smoking and statistical formula of median for calculating the average age have been employed for analysis. Results: Incidence of synchronous primaries has been found to be 1.33%, majority were seen at the oropharynx (39.2%) and 60.7% synchronous occurred at the esophagus, 0.81% of all head and neck cancers developed synchronous primary at the esophagus. Approximately, 65% of all synchronous primaries were in Stage III and Stage IV disease and 88.2% esophageal synchronous had Stage II disease. Association of UADT synchronous cancers with smoking is highly significant, relative risk = 1.95 95% confidence interval for relative risk 1.05-3.64 P = 0.00010981 (P < 0.05) and the average age is 62.4 years in males and 57.8 years in females. Conclusion: Patients who are at the high-risk for the development of synchronous primary tumors in the cancers of the head and neck region are patients with oropharyngeal carcinoma, smoking population, patients over the age of 62 years in males, and 57 years in females and in patients with higher staged index tumor.

Preventive effect of evidence-based nursing intervention program in patients at high risk of pres-sure ulcer in intensive care unit / 中国实用护理杂志

Objective To explore preventive effect of evidence-based nursing intervention program in patients at high risk of pressure ulcer in intensive care unit.Methods A total of 227 patients with risk evaluation score of Braden leas than 12 were randomly divided into the observation group (125 cases) and the control group (102 cases).The control group was only given regular nursing interventions.Patients in the observation group received evidence-based nursing interventions : including turning over per 2 hours, turning prostration to 30 degree left to fight inclined position, raising patient's head lower than 30 degree and putting a soft pillow under his/her heels; the patients whose risk evaluation score of Braden was less than 7, with cervical fracture or turning ever was limited by her/his situation needed to use air bed; comfeel transparent paste was used on the surface probably suffered from skin ulcer;, giving PN or EN according to patients' nutritional condition; keepping the skin around anus dryness.The incidence of pressure ulcer be-tween the two groups was compared.Results The incidence rate of pressure ulcer was siguificantly lower in the observation group than that in the control group.The occurring time significantly delayed and the sit-uation significantly better.Conclusions The evidence- based nursing inventions can lower the incidence rate of unavoidable pressure ulcer,reflect the scientific and artistic characteristics of nursing care, also effi-cient allocate limited nursing resources and reduce the incidence of pressure ulcer.

Clinical Application of the Delayed Procedure in the Distally Based Sural Flap

PURPOSE: Reconstruction of soft tissue defects with osteomyelitis in the lower third of the leg represents a challenge to plastic surgeons. Moreover, it is more arduous in multimorbid patients. One excellent option for reconstruction of these defects is to use a delayed distally based sural flap. METHODS: We successfully used delayed distally based sural flap with a two-step procedure. During the first operation, radical debridement and elevation of flap were performed. The raised flap was fixed again at the donor site. The delay period ranged from seven to ten days. Between August 2008 and July 2009, we underwent operations for five patients using this technique. The size of flap varied from 10 x 6 cm to 12 x 14 cm. RESULTS: All flaps successfully survived. Partial skin loss of the grafted site was seen in two patients but no further surgical procedure was required for wound healing. Complaints of hypoesthesia on the lateral part of the foot was observed. In a three month follow-up period, hypoesthesia was resolved spontaneously. CONCLUSION: Delayed procedure improves the viability of distally based sural flap in high risk, critically multimorbid patients. We recommend that, if a two-stage operative approach is required, the delayed procedure should be considered.

Eeffect of transurethral bipolar and resection bicyclol Plasma cutting on treatment of high-risk BPH / 中国基层医药

Objective To explore the high-risk patients with benign prostatic hypeiplasia using bipolar transurethral resection of prostate for the treatment of dual-loop electrosurgical excision of the safety .effectiveness.Methods To retrospectively analyze of 56 cases with high-risk BPH patients with United States bicyclol CIRCON ion bipolar TURP TURP mirror line.Results Operation time was 50～100 minutes,an average of 70 minutes.1 case of mild postoperative incontinence,1PSS score from(28.2 ±1.5)to(7.0 ±1.0).voiding patency,fewer complications.Conclusion 1.Lavage using normal saline to avoid TURS syndrome,operative time can be extended accordingly.2.The current through the body,suitable for patients with special diseases.3.Reducing the incidence of capsularperforation.4.Less bleeding and reduce the occurrence of postoperative complications.5.TURP plasma removal of prostate tissue without charring,suitable for histopathological examination,to avoid the TURP and TUVP undetected pathological examination,increased prostate cancer detection rate.

Combination of Antiemetics for the Prevention of Postoperative Nausea and Vomiting in High-Risk Patients

It was previously reported that the Korean predictive model could be used to identify patients at high risk of postoperative nausea and vomiting (PONV). This study investigated whether PONV in the high-risk and very high-risk patients identified by the Korean predictive model could be prevented by multiple prophylactic antiemetics. A total of 2,456 patients were selected from our previous PONV study and assigned to the control group, and 374 new patients were recruited consecutively to the treatment group. Patients in each group were subdivided into two risk groups according to the Korean predictive model: high-risk group and very high-risk group. Patients in the treatment group received an antiemetic combination of dexamethasone 5 mg (minutes after induction) and ondansetron 4 mg (30 min before the end of surgery). The incidences of PONV were examined at two hours after the surgery in the postanesthetic care unit and, additionally, at 24 hr after the surgery in the ward, and were analyzed for any differences between the control and treatment groups. The overall incidence of PONV decreased significantly from 52.1% to 23.0% (p< or =0.001) after antiemetic prophylaxis. Specifically, the incidence decreased from 47.3% to 19.4% (p< or =0.001) in the high-risk group and from 61.3% to 28.3% (p< or =0.001) in the very high-risk group. Both groups showed a similar degree of relative risk reductions: 59.0% vs. 53.8% in the high-risk and very high-risk groups, respectively. The results of our study showed that the antiemetic prophylaxis with the combination of dexamethasone and ondansetron was effective in reducing the occurrence of PONV in both high-risk and very high-risk patients.

Colecistectomia laparoscópica em pacientes de alto risco / Laparoscopic cholecystectomy in high risk patients

OBJETIVO: Relatar a experiência com a colecistectomia laparoscópica na colecistite aguda, em pacientes de alto risco (ASA 4). MÉTODO: De 1982 a 2001 foram realizadas, na Clínica Especializada em Doenças do Aparelho Digestivo (DIGEST), 1507 colecistectomias laparoscópicas, sendo 150 (10 por cento) em colecistite aguda, dentre as quais 10 (0,7 por cento) em pacientes ASA 4. RESULTADOS: Entre estes 10 pacientes observou-se uma faixa etária elevada com média de 70,9 anos (variando entre 50 e 89 anos), maior freqüência do sexo masculino (60 por cento), período de internação pré-operatório bastante variável (de três a 22 dias), prevalência elevada de colecistite aguda alitiásica (30 por cento) e grande freqüência de insuficiência renal (40 por cento) dentre as doenças associadas. Como complicações de pós-operatório houve uma coleção sub-hepática tratada por drenagem guiada por ultrassonografia; duas infecções de sítio operatório, tratadas pela abertura da pele do portal infectado, e um óbito decorrente da perpetuação do quadro séptico em paciente previamente submetido a colecistostomia percutânea. Não houve necessidade de conversão em nenhum dos pacientes operados. CONCLUSÃO: Os autores concluem pela viabilidade do método laparoscópico no tratamento da colecistite aguda em pacientes de alto risco, observando-se algumas estratégias específicas.

BACKGROUND: Evolution and experience with laparoscopic cholecystectomy in acute cholecystitis, a better knowledge of alterations provoked by the laparoscopic approach specially related to pneumoperitonium, allowed accomplishment of this procedure in high risk patients (ASA 4), objective of this research. METHODS: From 1992 to 2001, 1507 patients underwent laparoscopic cholecystectomy at Clínica Especializada em Doenças do Aparelho Digestivo (DIGEST), 150 (10 percent) of them with acute cholecistitis and 10 (0,7 percent) ASA 4 patients. RESULTS: Mean age was 70,9 years, varying between 50 and 89 years, and 60 percent were males. Preoperative hospitalization varied from 3 to 22 days. There was a 30 percent incidence of acute acalculous cholecystitis and 40 percent of renal disfunction. Other associated diseases were also observed. Postoperative complications included a sub-liver collection with associated pneumonia, solved by drainage guided by ultrasound, two surgical site infections, and a death due to perpetuation of sepsis on a patient previously submitted to a percutaneus cholecystostomy. None of the patients needed conversion to open surgery. CONCLUSIONS: We concluded that the laparoscopic technique approach in the treatment of acute cholecystitis in high risk patients is feasible, since some specific strategies are observed.

The Safety of a Laparoscopic Cholecystectomy in Acute Cholecystitis in High Risk Patients Older than Sixty

PURPOSE: To evaluate the safety of a laparoscopic cholecystectomy in acute, or complicated, cholecystitis in patients older than sixty. METHODS: A prospective study was performed, at the Ewha Womans University Mokdong Hospital, on a series of elderly patients (>60 years; n=137) who had undergone a laparoscopic cholecystectomy due to acute, or complicated, cholecystitis between March 1997 and December 2001. We divided the patients into 3 groups; ASA 1 (n=33, 24.1%), ASA 2 (n=79, 57.7%) and ASA 3 (n=25, 18.3%), according to their ASA (American Society of Anesthesiologist) classification. No patient was categorized as either ASA 4, 5 or 6. RESULTS: The mean age of the ASA 3 patients was 71.9+/-6.9 years, which was older than the 65.7+/-6.0 years of the ASA 1 patients (P0.05). One death, due to acute myocardial infarction, occurred in one of the ASA 3 patients. CONCLUSION: A laparoscopic cholecystectomy in acute, or complicated, cholecystitis could be an option in elderly-high risk patients.

The application of laparoscopic cholecystectomy with low pressure pneumoperitoneum for high risk patients with gallstone / 中国微创外科杂志

Objective To study the safety of laparoscopic cholecystectomy (LC) with low pressure pneumoperitoneum for high risk patients with gallstone. Methods 72 high risk patients with gallstones were undergone LC with low pressure pneumoperitoneum and their clinical data were analysed in our hospital during last three years. Results one of 72 patients was converted into open cholecystectomy due to bleeding, and two of them were converted due to severe adhesion. The others were performed successfully and no serious complications occurred. Conclusions LC is a safe method for high risk patients with gallstone. The key point is to use low pressure pneumoperitoneum during LC.