ABSTRACT
@#Objective To systematically evaluate the risk factors for hypoxemia after Stanford type A aortic dissection (TAAD) surgery. Methods Electronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and CBM were searched by computer to collect studies about risk factors for hypoxemia after TAAD published from inception to November 2021. Two authors independently assessed the studies' quality, and a meta-analysis was performed by RevMan 5.3 software. Results A total of 19 case-control studies involving 2 686 patients and among them 1 085 patients suffered hypoxemia, included 21 predictive risk factors. The score of Newcastle-Ottawa scale≥7 points in 16 studies. Meta-analysis showed that: age (OR=1.10, 95%CI 1.06 to 1.14, P<0.000 01), body mass index (OR=1.87, 95%CI 1.49 to 2.34, P<0.000 01), preoperative partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO2/FiO2)≤300 mm Hg (OR=7.13, 95%CI 3.48 to 14.61, P<0.000 01), preoperative white blood cell count (OR=1.34, 95%CI 1.18 to 1.53, P<0.000 1), deep hypothermic circulatory arrest time (OR=1.33, 95%CI 1.14 to 1.57, P=0.000 4), perioperative blood transfusion (OR=1.89, 95%CI 1.49 to 2.41, P<0.000 01), cardiopulmonary bypass time (OR=1.02, 95%CI 1.00 to 1.03, P=0.02) were independent risk factors for hypoxemia after TAAD surgery. Preoperative serum creatinine, preoperative myoglobin, preoperative alanine aminotransferase were not associated with postoperative hypoxemia. Conclusion Current evidence shows that age, body mass index, preoperative PaO2/FiO2≤300 mm Hg, preoperative white blood cell count, deep hypothermic circulatory arrest time, perioperative blood transfusion, cardiopulmonary bypass time are risk factors for hypoxemia after TAAD surgery. These factors can be used to identify high-risk patients, and provide guidance for medical staff to develop perioperative preventive strategy to reduce the incidence of hypoxemia. The results should be validated by higher quality researches.
ABSTRACT
【Objective】 To investigate the factors affecting the length of hospitalization after the Sun's procedure in patients with type A aortic coarctation. 【Methods】 From January 2018 to June 2023, the clinical data, related laboratory indicators and perioperative blood transfusion data of patients with type A aortic dissection who underwent Sun's procedure in the First Hospital of Lanzhou University were collected. LASSO regression was used to screen the characteristics related to the length of hospital stay, and linear regression analysis was used to determine the risk factors for prolonged length of hospital stay. 【Results】 The statistical analysis of 242 patients showed that the amount of red blood cell transfusion, plasma transfusion, platelet transfusion and autologous blood transfusion were the influencing factors of the length of hospital stay in patients with type A aortic dissection after operation. The total sum of squared deviations of the linear regression equation fitting the total length of hospital stay was statistically significant (F= 10.504, P<0.001). 【Conclusion】 Perioperative red blood cell transfusion,plasma transfusion,platelet transfusion and autologous blood transfusion are risk factors for prolonged postoperative hospitalization in patients undergoing the Sun's procedure for type A aortic coarctation. Control of operation time and reduction of intraoperative blood loss may help to prevent prolonged postoperative hospital stay and other adverse conditions.
ABSTRACT
Objective:To explore the effect of nurse-led multi-disciplinary team management on postoperative gastrointestinal function and nutritional status in elderly colon cancer inpatients.Methods:A total of 75 elderly inpatients after colon cancer operation who met eligibility criteria and signed informed consent form were randomized into study (n=37) or control group (n=38), receiving nurse-led multi-disciplinary team management or routine nursing for 6 months, respectively. The gastrointestinal function, days of postoperative hospital stay, body weight, body composition and dietary intake were compared between the two groups.Result:Compared to the control group, time to defecation (t=14.79, P<0.01), time to initiation of liquid diet intake (t=6.80, P<0.01), time to initiation of semi-liquid diet intake (t=10.78, P<0.01) and days of postoperative hospital stay (t=8.76, P<0.01) in the study group were significantly shortened; and body weight [(59.44±6.12)kg vs. (62.54±6.41)kg, P=0.004], BMI [(19.02±4.13)kg/m 2 vs. (19.98±3.98)kg/m 2, P=0.025], body fat percentage [(20.03±3.55)% vs. (21.34±3.68)%, P<0.01], lean body mass [(19.63±3.44)kg vs. (21.45±3.16)kg, P<0.01], grip strength [(21.65 ± 3.56) kg vs. (22.48 ± 3.81) kg, P=0.011], attainment rate of 75% target energy intake (65.8% vs. 86.5%, P=0.036) and attainment rate of 75% target protein intake (57.9% vs. 83.8%, P=0.014) were significantly improved in study group 6 months after operation. Conclusion:The nurse-led multi-disciplinary team management can effectively improve the postoperative recovery of gastrointestinal function and the long-term nutritional status in elderly patients with colon cancer.
ABSTRACT
@#AIM: To investigate the repairment of wound by using soft contact lenses and rb-bFGF eye drops after deep foreign body removal.<p>METHODS: Patients with deep corneal foreign body(72 cases, 72 eyes)were randomly separated into three groups and received surgery to remove the foreign bodys. Patients in group C only accepted levofloxacin eye drops and ofloxacin eye ointment while patients in group A wore soft contact lenses and group B received rb-bFGF eye drops as an extra after operation. The corneal irritation and pain(1, 3, 5d), wound healing(1wk)and relevant factors in visual acuity impairment(1mo)were observed after deep foreign body removal.<p>RESULTS: Corneal irritation and pain scores in group A were significantly lower than that in the other two groups at 1, 3 and 5d after operation. Patients felt less painful in group B than group C at 3 and 5d. Corneal wound healing in groups A and B was significantly higher than group C at 1wk after surgery(<i>P</i>>0.05). The closer corneal foreign body was to the pupil area, the more vision was affected after 1mo operation(<i>r</i>s=0.635, <i>P</i><0.05).<p>CONCLUSION: Soft contact lenses can effectively alleviate eye irritation after deep corneal foreign body removal in early time. Both SCL and rb-bFGF eye drops can accelerate the recovery of corneal wounds. Visual acuity impairment was closely related to the location of foreign body in deep corneal.
ABSTRACT
@#AIM: To evaluate the effectiveness and safety of intravitreal injection of ranibizumab combined with Ahmed drainage valve implantation compared to pure Ahmed drainage valve implantation in the treatment of NVG.<p>METHODS: Computers were used to search PubMed, EMbase, Cochrane Library, American Scientific Citation Index Database(SCI), China Knowledge Network(CNKI), Chinese Science and Technology Journal Database(VIP), Wanfang Database, China Biomedical Document Service System(CBM), and to find literature about ranibizumab and Ahmed drainage valve implantation in the treatment of NVG. At the same time, relevant references were consulted. The search time limit was establishment until March 20, 2020. Quality evaluation and data extraction on the included studies were performed. RevMan 5.3 and STATA 12.0 software were used for Meta-analysis.<p>RESULTS: The included 7 clinical studies included 346 patients(349 eyes), and the quality was evaluated as medium to high quality. The homogeneity of the basic characteristics of various studies was better. Compared with the pure Ahmed drainage valve implantation group(the control group), the ranibizumab combined with Ahmed drainage valve implantation group(the experimental group)had lower intraocular pressure at 1wk and 1mo after surgery. There was no statistical difference at 6mo after surgery. The BCVA of the experimental group was better than that of the control group at 1mo and 3mo, and there was no significant difference at 6mo after surgery. There was no significant difference in the rate of anterior chamber bleeding and the number of anti-glaucoma drugs used between the two groups.<p>CONCLUSION: Compared with pure Ahmed drainage valve implantation, ranibizumab combined with Ahmed drainage valve implantation has better postoperative intraocular pressure and best corrected visual acuity in the early stage in the treatment of NVG, and the difference in the late postoperative period is not significant. It cannot reduce the rate of postoperative anterior chamber bleeding, and cannot reduce the use of anti-glaucoma drugs. This conclusion needs to be further confirmed by more high-quality clinical randomized controlled studies.
ABSTRACT
@#AIM:To retrospectively analyze the effect of Qiming Granules combined with Deproteinized Calfblood Extract Eye Gel in the treatment of diabetes phaeoemulsification postoperative xerophthalmia.<p>METHODS:From June 2017 to June 2018, 147 diabetics 269 eyes were diagnosed with phaeoemulsification postoperative xerophthalmia were enrolled in our study. The control group was given the Tobramycin Dexamethasone Eye Drops and Diclofenac Sodium Eye Drops, the Sugaojie group was given Deproteinized Calfblood Extract Eye Gel on the basic of the control group, the combined group was given the Qiming Granules on the basic of the Sugaojie group. The courses all last 4wk. The corneal fluorescence staining, BUT and SⅠt were analyzed before, and post 1mo after treatment, and the clinical efficacy of each group was analyzed.<p>RESULTS: There was no difference among three groups on BUT and SⅠt before treatment(<i>P</i>>0.05). After 1 mo treatment, BUT and SⅠt of the Sugaojie group and the combined group were significantly improved compared to the control group(<i>P</i><0.05), furthermore, the combined group did better role on BUT, SⅠt and total effective rate compared to the Sugaojie group(97.9%<i> vs </i>89.0%, <i>P</i>=0.013).<p>CONCLUSION: Qiming Granules combined with Deproteinized Calf blood Extract Eye Gel could improve xerophthalmia after phaeoemulsification surgery. It is a positive and effective treatment, which has good clinical application significance.
ABSTRACT
OBJECTIVE： To compare the efficacy and safety of domestic vancomycin and imported vancomycin in the treatment of methicillin-resistant Staphylococcus aureus （MRSA） caused lung infection after neurosurgery. METHODS： The patients after neurosurgery with MRSA pulmonary infection diagnosed in our hospital from Jan. 2014 to Jun. 2015 and using domestic vancomycin were included in domestic vancomycin group， while those who used imported vancomycin from Jul. 2015 to Dec. 2018 were included in imported vancomycin group. The baseline data of the two groups were matched by 1 ∶ 1 according to propensity score matching method. The 30-day all-cause mortality， 90-day all-cause mortality of severe patients， 7 d effective bacterial clearance rate and the incidence of ADR were compared between 2 groups. RESULTS： There were 108 cases in domestic vancomycin group and 279 cases in imported vancomycin group. After propensity score matching， 108 cases in domestic and 108 cases in imported vancomycin group were finally included. The 30-day mortality rates of domestic group and imported group were 10.19％（11/108） and 7.41％（8/108） respectively， and the 90-day all-cause mortality of 22 pairs of severe patients were 63.64％. The 7 d effective bacterial clearance rates were 75.00％（48/64） and 81.94％（59/72）， and there was no statistical significance （P＞0.05）. The incidences of creatinine increase ＞1 fold were 25.93％（28/108） and 12.04％（13/108）， the total incidences of ADR were 29.63％（32/108） and 15.74％（17/108）， respectively， with statistical significance （P＜0.05）. CONCLUSIONS： The therapeutic efficacy of imported vancomycin is similar to that of domestic vancomycin in the treatment of postoperative pulmonary infection with MRSA after neurosurgery， but the safety needs to pay close attation， especially the rise of serum creatinime.
ABSTRACT
Objective To study the effect of high-flow nasal cannula oxygen therapy (HFNC) in reduction in re-intubation rate, length of ICU stay and improvement of respiratory function in patients with high cervical spinal cord injury.Methods Single center retrospective study was carried out in our intensive care unit from September 2016 to March 2018. Post-operative patients ready for planned extubation with high cervical spinal cord injury were included. The length of ICU stay, re-intubation rate in case of respiratory failure, respiratory rate, pulse rate, MAP, SaO2, PaO2/FiO2, and PaCO2 of patients at 6, 24 and 72 h after extubation were compared between the HFNC and conventional oxygen therapy (COT) groups. Results During the study period, 38 patients were enrolled in the study. Of them, 16 patients were assigned in the HFNC group and 22patients in the COT group. Re-intubation rate was significantly different between the two groups (18.8％ vs 27.3％, P<0.05), but the length of ICU stay had no significant difference [(15.5±3.4) days vs (16.6±5.2) days]. The respiratory rate, pulse rate, SaO2 and PaO2/FiO2 at 6 h after extubation in the HFNC group were improved markedly than those in the COT group (P<0.05); and the PaCO2 and PaO2/FiO2 at 24 and 72 h after extubation in the HFNC group had much more improvement than those in the COT group (P<0.05). Conclusions Among individuals with post-operative high cervical spinal cord injury, high-flow oxygen therapy could reduce re-intubation rate, and PaCO2 level, and improve the respiratory function, but cannot reduce the length of ICU stay. High-flow oxygen therapy may offer advantages for patients with high cervical spinal cord injury.
ABSTRACT
OBJECTIVE@#To explore the clinical efficacy and action mechanism of auricular point pressing combined with electroacupuncture (EA) on postoperative pain in children with hernia.@*METHODS@#A total of 93 children with inguinal hernia were randomly divided into an auricular point group, an EA group and a combination group, 31 cases in each group. All the three groups were treated with routine postoperative treatment and nursing, and analgesic and sedative drugs were used when necessary. After awaking, the children in the auricular point group were treated with auricular point pressing at Shenmen (TF), Jiaogan (AH) and Pizhixia (AT); the seeds of cowherb were placed at the auricular points and the same nurse used index finger and thumbs to press the points for 2 min, and repeated after 30 min. The pressing time was 8-11 AM and 14-17 PM for 3 days. The children in the EA group were treated with EA at Sanyinjiao (SP 6) and Zusanli (ST 36); the needles were perpendicularly inserted with mild reinforcing-reducing method; EA instrument was connected with needles and the current intensity was under the maximal tolerance of children; the needles were retained for 20 min, three times a day for continuous 3 days. The children in the combination group were treated with auricular point pressing and EA for 3 days. The Wong-Baker facial expression evaluation method was used to observe the pain scores 1-3 h, 4-24 h, 25-48 h and 49-72 h after operation; the contents of TNF-α, IL-6 and IL-8 were compared 1 day, 2 days and 3 days after operation; the number of cases using sedative drugs and average hospitalization days were compared among the three groups.@*RESULTS@#①Among the children aged 8-15 years old, the pain scores 4-24 h and 25-48 h after operation in the combination group were lower than those in the auricular point group and the EA group (all 0.05). ②The contents of TNF-α, IL-6 and IL-8 in serum 1 day, 2 days and 3 days after operation in the combination group were lower than those in the auricular point group and the EA group (all <0.05). ③The number of cases using analgesic and sedative drugs after operation in the combination group was fewer than that in the auricular point group and the EA group (all <0.05). ④The average hospitalization days in the combination group were shorter than those in the auricular point group and the EA group (all <0.05).@*CONCLUSION@#Compared with auricular point pressing or EA alone, the combination of auricular point pressing and EA could not only effectively relieve the postoperative pain, but also reduce the expression of inflammatory cytokines in children with hernia, improving the clinical efficacy.
Subject(s)
Adolescent , Child , Child, Preschool , Humans , Cytokines , Metabolism , Electroacupuncture , Hernia , Allergy and Immunology , Therapeutics , Pain, Postoperative , Treatment OutcomeABSTRACT
Exocrine pancreatic insufficiency is a commom complication after pancreatic operation with high morbidity.At present,surgeons have insufficient understanding of it,and there is no internationally normalized standard for the diagnosis and treatment of exocrine pancreatic insufficiency.Through systematic reviewing of the relevant literature,this review summarizes the research progress of exocrine pancreatic insufficiency after pancreatic operation,including the definition of exocrine pancreatic insufficiency,aetiological agent,diagnosis,treatment,prevention,and morbidity of pancreatic exocrine insufficiency in different surgical procedures,in order to provide a reference for the improvement of diagnosis and treatment of exocrine pancreatic insufficiency in the future.
ABSTRACT
BACKGROUND@#The aim of this study was to analyze the incidence of lower limb deep venous thrombosis (DVT) and the corresponding coagulation status in severe patients after thoracic surgery.@*METHODS@#Severe patients after thoracic surgery who received mechanical prophylaxis of lower limb DVT between July 2016 and June 2018 were analysed retrospectively. Their general information, disease species, surgical treatment, and coagulation index were reviewed.@*RESULTS@#Fifty patients were finally included. There were 34 male and 16 female, aging from 22 to 80 years. The incidence of DVT was 22.0%, all of them were isolated calf DVT. The incidence was 29.4% in male patients, while 6.3% in female; 23.5% in malignant diseases and 18.6% in benign. All coagulation index presented no statistical difference between patients with and without DVT, except activated partial thromboplastin time (APTT).@*CONCLUSIONS@#Even on the basis of adequate mechanical prophylaxis, lower limb DVT is common in severe patients after thoracic surgery. Meanwhile, male patients and malignant diseases are more suscepted.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Blood Coagulation , Incidence , Lower Extremity , Lung Neoplasms , General Surgery , Retrospective Studies , Thoracic Surgical Procedures , Venous ThrombosisABSTRACT
Objective To analyze the effect of evidence based practice on feeding after spinal operation. Methods To formulate an answerable question, find the best available evidence, appraise the evidence and formulate the recommendations by using the method of evidence-based medicine. A total of 60 postoperative patients who received spinal operation were divided into observation group and control group (30 cases in each group). Those patients in control group received the routine diet guidance and the guidelines for the standardization of intake and consumption after spinal cord surgery were used for patients in observation group. The outcomes were evaluated by postoperative recovery and complications of patients after spinal operation. Results There were no significant difference in the incidence of nausea, vomiting , bloating and celialgia in the 5 hours after surgery and 2 hours after feeding between the two groups (P>0.05). The incidence of thirst and hunger in the 5 hours after surgery in observation group were 3.33％(1/30) and 13.33％(4/30).The incidence of thirst and hunger in the 5 hours after surgery in control group were 80.00％(24/30) and 83.33％(25/30). There were statistically significant in the incidence of thirst and hunger in the 5 hours after surgery between the two groups (χ2=36.27, 24.09, P<0.05). There were not statistically significant in the time of anal exsufflation and first defecation time between the two groups(P>0.05). Conclusions Evidence-based practice in the use of guidelines for the standardization of intake and consumption after spinal cord surgery can guide clinical practice.
ABSTRACT
Gallbladder cancer occurs insidiously and is usually induced by basic gallbladder diseases accompanied with chronic inflammation. Surgical operation can remove cancerous focus but further treatment should be applied to relieve complications and prevent recurrence and metastasis. According to TCM theory, the basic pathogenesis of post-operation of gallbladder cancer is the combination of blood stasis and heat. Blood stasis arises from surgical operations, failure of liver-gallbladder in keeping smooth flow of qi, and dampness retention in middle-Jiao. Heat arises from qi-stagnation, phlegm-dampness, blood stasis and yin-blood deficiency. Therefore, this article proposed that the therapeutic methods should include Qingre Huoxue Method (clearing away heat and promoting blood circulation), keeping smooth qi-flow of liver-gallbladder, and removing dampness and discharging waste, with typical clinical cases for illustration.
ABSTRACT
Objective To observe the clinical effect of arthroscopic surgery on patients with rotator cuff tear injury. Methods One hundred and twenty patients with rotator cuff tears admitted to the Department of Orthopaedic of the First Hospital of Changsha from January 2013 to September 2015 were enrolled. Sixty patients treated with traditional conservative methods were assigned in a control group, the whole arthroscope or shoulder arthroscope was used to assist performing microsurgical incisions for another such 60 patients in the observation group. Visual analogue scale (VAS) of pain was applied to evaluate the pain of the patients with rotator cuff injury before and after treatment in both groups. The function of the shoulder joints and recovery situation were evaluated by using the shoulder functional system score and the American shoulder and elbow surgeon score (ASES). Results The results showed that all patients had no postoperative complications such as secondary fracture of the rotator cuff tear, infection, incision non-healing, etc. Compared with those before treatment, in both groups, the VAS scores were obviously lowered after treatment, while ASES and shoulder function system scores after treatment were significantly higher than those before treatment, and the changes in the observation group were more pronounced than those in the control group (VAS: 0.82±0.11 vs. 2.20±0.59, ASES: 82.21±10.81 vs. 70.53±6.21, pain score: 9.81±0.21 vs. 9.11±0.51, function score: 9.70±0.09 vs. 8.80±0.40, anterior flexion score: 4.59±0.41 vs. 4.20±0.61, all P ＜ 0.05). Conclusion The clinical effect of arthroscopic surgical treatment of patients with rotator cuff tear injury is relatively satisfactory and worthy to be deeply studied clinically.
ABSTRACT
Objective To explore the effect of using cluster nursing measures on expectoration in mechanical ventilation patients after craniocerebral operation. Methods Convenient sampling and controlled trials at not the same period were used. Sixty-seven mechanical ventilation patients after craniocerebral operation were selected as the research objects in Department of Neurosurgery Intensive Care Unit (ICU) of the First Hospital Affiliated to Wenzhou Medical College. Thirty-two patients treated from June 2015 to June 2016 were assigned in the control group, and they were given routine respiratory nursing care; 35 patients admitted and treated from July 2006 to July 2017 were included in the intervention group, and they were given evidence-based cluster nursing intervention measures on the basis of routine care. The differences in expectoration effect, arterial blood gas analysis index, incidence of pulmonary infection and prognosis of patients in two groups were compared. Results Compared with control group, the amount of expectoration in the intervention group was significantly increased (mL/d: 49.69±9.45 vs. 33.72±10.63, P < 0.05), while the daily number of sputum suction (times: 21.57±2.31 vs. 28.76±22.66), the time needed for each sputum suction(s: 6.81±1.74 vs. 9.28±2.52), respiratory frequency (bpm: 26.26±1.83 vs. 28.58±1.36), incidence of pulmonary infection [0 vs. 12.5% (4/32)], time of mechanical ventilation (days: 6.37±2.51 vs. 8.92±3.32), time of ICU stay (days: 7.49±3.87 vs. 10.33±2.12), time of hospital stay (days: 10.31±1.99 vs. 14.56±3.57), fatality rate [8.6% (3/35) vs. 21.9% (7/32)] in the intervention group were significantly decreased (all P < 0.05); after treatment the arterial partial pressure of oxygen (PaO2) and pulse oxygen saturation degree (SpO2) were significantly increased than those before treatment, and the arterial partial pressure of carbon dioxide (PaCO2) was significantly decreased than that before treatment, and the degrees of improvement in the intervention group on 5 days were significantly better than those in the control group [PaO2(mmHg, 1 mmHg = 0.133 kPa): 60.89±3.44 vs. 57.34±2.49, PaCO2(mmHg): 41.06±4.32 vs. 45.22±4.78, SpO2: 0.986±0.030 vs. 0.963±0.023, all P < 0.05]. Conclusion The cluster nursing measures can effectively improve the expectoration effect for mechanical ventilation patients after craniocerebral surgery, reduce the mortality and incidence of pulmonary infection, shorten the stay in ICU and improve the prognosis, suggesting that the measures be worthy to be applied widely in clinics.
ABSTRACT
Physical activity is closely related to the quality of life of postoperative patients with breast cancer, which is expressed in fre-quency, duration, intensity, and others factors. There is no uniform measurement of physical activity, the common measurements may be classified as subjective and objective, such as exercise log, physical activity questionnaire and self-reported physical activities of the former;doubly labeled water, indirect calorimetry, motion sensors and heart rate monitors of the latter. The age, educational level, social and eco-nomic status, and body mass index are related to the level of physical activity in patients post operation for breast cancer, while illness and treatment, psychological and social support, and health-related quality of life also affect the level of physical activity, which suggest that such patients need to improve their physical activity before operation.
ABSTRACT
Objective Postoperative acute pulmonary embolism (PE) is a high risk complication with high mortality.The aim of this study was to analyze the risk factors for postoperative acute PE and the effect of anticoagulation treatment on the complication and prognosis. Methods Ninety four postoperative patients diagnosed with acute PE by spiral CT pulmonary angiography examination from March 2011 to April 2014 were enrolled.The patients were divided into 2 groups.Group A:Postoperative patients without other risk fac-tors of PE (tumor, pregnancy/delivery, heart failure, COPD, long-term bedridden because of internal diseases , hypertension, coronary heart disease, stroke, atrial fibrillation and deep venous thrombosis of lower limb and PE history );Group B:Postoperative patients with other risk factors of PE .The clinical data werecollected and analyzed including the risk factors of PE , examination results when PE oc-curred ( blood pressure, respiratory rate, heart rate, blood gas analysis, the level of serum D-dimer and BNP), method of treatment, bleeding complications and prognose . Results The oxygen pressure of group A was obviously higher than that of group B ( 87.36 ±23.06 mmHg vs 74.43±24.7 mmHg, P<0.05); the level of serum BNP in group A was lower than that in group B ( 945.64 ±1407.64 pg/mL vs2639.143±4070.375 pg/mL, P<0.05).The rate of anticoagulant therapy was significantly lower in group B than that in group A (90%vs 100%P<0.05) .The mortality of group B was higher than that of group A ( P<0.05) .The therapy method of anticoagulant and thromboly-sis had positive correlation with bleeding complications ( P<0.05) .The therapy method of anticoagulant had negative correlation with the mortality of acute PE, while the tumor, increase in serum BNP increasing , hypoxemia and hypotension had positive correlation with the mortality of acute PE (P<0.05). Conclusion The therapy method of anticoagulant and thrombolysis can increase the risk of bleeding complications of postoperative patients diagnosed with acute PE , while the therapy method of anticoagulant can reduce the risk of death of these patients.The tumor, increase in serum BNP , hypoxemia and hypotension can increase the risk of death .
ABSTRACT
Objective Postoperative acute pulmonary embolism (PE) is a high risk complication with high mortality.The aim of this study was to analyze the risk factors for postoperative acute PE and the effect of anticoagulation treatment on the complication and prognosis. Methods Ninety four postoperative patients diagnosed with acute PE by spiral CT pulmonary angiography examination from March 2011 to April 2014 were enrolled.The patients were divided into 2 groups.Group A:Postoperative patients without other risk fac-tors of PE (tumor, pregnancy/delivery, heart failure, COPD, long-term bedridden because of internal diseases , hypertension, coronary heart disease, stroke, atrial fibrillation and deep venous thrombosis of lower limb and PE history );Group B:Postoperative patients with other risk factors of PE .The clinical data werecollected and analyzed including the risk factors of PE , examination results when PE oc-curred ( blood pressure, respiratory rate, heart rate, blood gas analysis, the level of serum D-dimer and BNP), method of treatment, bleeding complications and prognose . Results The oxygen pressure of group A was obviously higher than that of group B ( 87.36 ±23.06 mmHg vs 74.43±24.7 mmHg, P<0.05); the level of serum BNP in group A was lower than that in group B ( 945.64 ±1407.64 pg/mL vs2639.143±4070.375 pg/mL, P<0.05).The rate of anticoagulant therapy was significantly lower in group B than that in group A (90%vs 100%P<0.05) .The mortality of group B was higher than that of group A ( P<0.05) .The therapy method of anticoagulant and thromboly-sis had positive correlation with bleeding complications ( P<0.05) .The therapy method of anticoagulant had negative correlation with the mortality of acute PE, while the tumor, increase in serum BNP increasing , hypoxemia and hypotension had positive correlation with the mortality of acute PE (P<0.05). Conclusion The therapy method of anticoagulant and thrombolysis can increase the risk of bleeding complications of postoperative patients diagnosed with acute PE , while the therapy method of anticoagulant can reduce the risk of death of these patients.The tumor, increase in serum BNP , hypoxemia and hypotension can increase the risk of death .
ABSTRACT
BACKGROUND/AIMS: Helicobacter pylori eradication is recommended in patients with early gastric cancer. However, the possibility of spontaneous regression raises a question for clinicians about the need for “retesting” postoperative H. pylori status. METHODS: Patients who underwent curative gastrectomy at Seoul National University Bundang Hospital and had a positive H. pylori status without eradication therapy at the time of gastric cancer diagnosis were prospectively enrolled in this study. H. pylori status and atrophic gastritis (AG) and intestinal metaplasia (IM) histologic status were assessed pre- and postoperatively. RESULTS: One hundred forty patients (mean age, 59.0 years; 60.7% male) underwent subtotal gastrectomy with B-I (65.0%), B-II (27.1%), Roux-en-Y (4.3%), jejunal interposition (0.7%), or proximal gastrectomy (4.3%). Preoperative presence of AG (62.9%) and IM (72.9%) was confirmed. The mean period between surgery and the last endoscopic follow-up was 38.0±25.6 months. Of the 140 patients, 80 (57.1%) were found to be persistently positive for H. pylori, and 60 (42.9%) showed spontaneous negative conversion at least once during follow-up. Of these 60 patients, eight (13.3%) showed more complex postoperative dynamic changes between negative and positive results. The spontaneous negative conversion group showed a trend of having more postoperative IM compared to the persistent H. pylori group. CONCLUSIONS: A high percentage of spontaneous regression and complex dynamic changes in H. pylori status were observed after partial gastrectomy, especially in individuals with postoperative histological IM. It is better to consider postoperative eradication therapy after retesting for H. pylori.
Subject(s)
Humans , Diagnosis , Follow-Up Studies , Gastrectomy , Gastritis, Atrophic , Helicobacter pylori , Helicobacter , Metaplasia , Prospective Studies , Seoul , Stomach NeoplasmsABSTRACT
Objective To evaluate the value of fecal calprotectin (FC) and stool lactoferrin (SL) for detecting endoscopic activity and monitoring postoperative recurrence of Crohn disease.Methods Publications in Pubmed,Embase,Science Direct,Springer Link,CBM,Cnki,Wan fang and VIP database before January 1 st 2016 were searched manually.Papers were screened according to inclusion and exclusion criteria.Quality assessment was conducted by QUADAS-2 scale.Meta-Disc 1.4 was used to analyze the heterogeneity of included articles.The pooled sensitivity,specificity,positive likelihood,negative likelihood were calculated respectively and the SROC curve was drawn.Stata 12.0 was used to assess the publication bias.Results A total of 19 papers in English language were included.The pooled sensitivities of FC,SL in detecting endoscopic activity and FC in monitoring postoperative recurrence of Crohn disease were 86％ (95％ CI:84％-88％),72％ (95 ％ CI:66％-79％),80％ (95％ CI:75％-84％),respectively.The specificities were 71％ (95％CI:67％-75％),84％ (95％ CI:74％-91％),65％ (95％ CI:59％-70％),respectively.The areas under the SROC curve were 0.865 6,0.834 6,0.811 0 respectively.The cut-off values of FC in detecting endoscopic activity of Crohn disease were set to ＜ 100 μg/g,100-＜200 μg/g or ≥ 200 μg/g with the area under the SROC curve being 0.898 7,0.788 8,0.888 8,respectively.The cut-off values of FC in monitoring postoperative recurrence of Crohn disease were set to 100-＜ 150 μg/g,150-＜200 μg/g or ≥ 200 μg/g with the areas under the SROC curve being 0.677 4,0.859 4 and 0.759 5,respectively.Conclusion FC and SL have higher diagnostic efficiency than C-reaction protein and are worthy of clinical promotion in detecting endoscopic activity and monitoring postoperative recurrence of Crohn disease.However,endoscopy cannot be replaced.