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Objective To investigate the death prognosis and risk factors of extensively drug-resistant Acinetobacter baumannii in hospitalized elderly patients with hematological infection, so as to facilitate clinical prevention and treatment. Methods The elderly (> 80 years old) hospitalized patients with hematological infection in our hospital from 2015 to 2021 were selected for analysis. Firstly, 314 patients with extensively drug-resistant Acinetobacter baumannii hematological infection were distinguished by etiological analysis. A total of 98 cases of death were detected during hospitalization (later referred to as the observation group). By comparing with the surviving patients (216 cases) (later referred to as the control group), the general data of patients with XDRAB infection were collected, and the risk of death and its influencing factors were analyzed. Results In the study, the proportion of patients in the observation group who used catheters was higher, the catheter retention time was longer, the acute physiology and chronic health status II scores were higher, and the proportion of patients who lost self-care ability was also higher. Conclusion The death of blood borne infection of extensively drug-resistant Acinetobacter baumannii in elderly patients is affected by many factors. Among them, patients who use catheters for a long time, have poor self-care ability and lose self-care ability have a higher risk of death, which is worthy of clinical attention.
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Objective:To retrospectively analyze the incidence, mortality, clinical characteristics and related factors of transient and persistent acute kidney injury in patients with sepsis in emergency department.Methods:Patients with sepsis ≥ 18 years old hospitalized in the Emergency Department of Guangdong Provincial Hospital of Chinese Medicine from June 2018 to May 2020 were selected as the research objects. According to the renal function injury at admission and the renal function recovery at 48 h after admission, patients with sepsis were divided into three groups: non-S-AKI group, transient S-AKI group, and persistent S-AKI group.Results:A total of 197 patients with sepsis were included, including 95 patients with non-S-AKI, 39 patients with transient S-AKI and 63 patients with persistent S-AKI. The mortality in the persistent S-AKI group was significantly higher than that in the non-S-AKI group (36.5% vs. 17.9%, P<0.05), but there was no significant difference between the transient S-AKI group and non-S-AKI group (20.5% vs. 17.9%, P>0.05). Multiple categorical disordered Logistic regression analysis showed that urea was associated with transient S-AKI ( OR=1.440, 95% CI: 1.235-1.680), and age ( OR=1.049, 95% CI: 1.008-1.092), urea ( OR=1.440, 95% CI: 1.277-1.733), and infection site in non-urinary tract ( OR=0.149, 95% CI: 0.050-0.448) were associated with persistent S-AKI. Conclusions:The incidence of persistent S-AKI is higher than that of transient S-AKI. Persistent S-AKI is related to the prognosis of patients with sepsis, and the mortality rate is higher, while transient S-AKI has no significant relationship. The urea of patients with S-AKI would increase significantly, and advanced age and urinary tract infection are related factors for the occurrence of persistent S-AKI. For patients with sepsis with such factors, attention should be paid to early protection of renal function to prevent persistent S-AKI.
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OBJECTIVE@#To evalvate efficacy of Qizi Yusi Pills (QYP), a Chinese medicine compound preparation, on in vitro fertilization-embryo transfer (IVF-ET) in women of advanced reproductive age.@*METHODS@#This multicenter, randomized, double-blind, placebo-controlled trial was conducted from June 2018 to October 2019. A total of 124 patients were randomly allocated to either the QYP group or the placebo group using a stratified block randomization design, with 62 patients in each group. All patients completed controlled ovarian stimulation using a standard gonadotropin-releasing hormone agonist (GnRH-a) long protocol. As the QYP group, QYP was administered while the control group received placebo. QYP and placebo were administered for a total of 24 to 30 days from the day of GnRH-a pituitary downregulation to transvaginal oocyte retrieval. Both medications were taken orally at doses of 10 g three times each day. The primary outcome was cumulative pregnancy rate, and the secondary outcomes were periodic medication, follicular status, serum hormone and endometrial receptivity. Follow-up continued until 4 weeks after delivery. Maternal and neonatal complications, such as gestational diabetes, were also observed.@*RESULTS@#Overall, 119 patients completed the study, 60 in the QYP group and 59 in the placebo group. Per protocol (PP) analysis revealed that 6-month cumulative pregnancy rate in the QYP group was significantly higher than that in the placebo group [43.33% (26/60) vs. 25.42% (15/59), P=0.040). Additionally, more oocytes were retrieved from the QYP group than those from the placebo group (8.95 ± 3.12 vs. 7.85 ± 1.91, P=0.022). Moreover, the endometrial thickness of HCG day in the QYP group was significantly higher than that in the placebo group (11.78 ± 2.27 mm vs. 10.68 ± 2.07 mm, P=0.012). Maternal and neonatal complications between the two groups were not significantly different (P>0.05). Intention-to-treat analysis was in line with PP results.@*CONCLUSIONS@#QYP can enhance ovarian reserve capacity and ovarian response, and possibly promote endometrial receptivity. QYP effectively improves cumulative pregnancy rates in older patients (⩾35 years) undergoing IVF-ET. (Registration No. ChiCTR1800014427).
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Female , Humans , Pregnancy , Drugs, Chinese Herbal/therapeutic use , Embryo Transfer , Fertilization in Vitro , Gonadotropin-Releasing Hormone/agonists , Ovulation Induction , Pregnancy Outcome , Pregnancy RateABSTRACT
Objective:To investigate the clinical effect of long-stem hemiarthroplasty in the treatment of unstable intertrochanteric fracture in elderly patients with severe osteoporosis.Methods:A retrospective analysis was performed on 48 elderly patients with unstable intertrochanteric fractures of the femur with severe osteoporosis in Liaocheng People′s Hospital from April 2017 to April 2019.Twenty three patients received long-stem hemiarthroplasty (LHA group). Twenty five patients were treated with proximal femoral nail anti-rotation (PFNA) (PFNA group). PFNA group was used as the control group.The operative time, intraoperative blood loss, perioperative blood transfusion volume, number of intraoperative fluoroscopy, weight-bearing time after operation, the incidence of postoperative complications, hospitalization time, and Harris hip score of 1, 3, 6, 12 months after surgery, to investigate the efficacy of the application of long-stem hemiarthroplasty.Results:In LHA group, 23 patients were followed up for (18.6±3.9) (range from 12.0 to 26.0) months, and 25 patients in the PFNA group were followed up for (17.8±3.3)(range from 12.0 to 24.0) months.There was no significant difference in follow-up time between the two groups ( Z=-0.552, P=0.581). The operation time of LHA Group (60 (55, 73) h) was longer than that of PFNA Group (55 (50, 60) h). The intraoperative blood loss in LHA Group ((179.35±63.47) mL) was more than that in PFNA Group ((122.80±49.03) mL). The number of fluoroscopy in LHA Group (2 (2, 2) times)was less than that in PFNA Group (16 (14.5, 19.5) times). The time of weight bearing in LHA Group (4 (3, 5) d) was earlier than that in PFNA Group (33 (30, 36) d), and the differences were statistically significant ( Z=2.459, t=3.470, Z=6.216, Z=5.959; all P<0.05). There were no significant differences in perioperative blood transfusion, hospital stay and postoperative complications between the two groups (all P>0.05). Harris hip function score was significantly higher in LHA Group ((76.70±5.96), (82.13±6.38), (85.96±7.16), (88.78±7.67) points) and PFNA Group ((63.80±3.46), (71.56±2.55), (81.60±3.38), (88.08±4.83) points) increased gradually with the increase of follow-up time ( Fintra-group=432.557, Pintra-group<0.001), and the score reached the highest 12 months after operation.Harris hip function score of LHA group was higher than that of PFNA group( Finter-group=25.437, Pinter-group<0.001). There was interaction effect between follow-up time point and operation mode( Finteraction=53.464, Pinteraction<0.001). Conclusion:For the elderly patients with unstable intertrochanteric fracture with severe osteoporosis, the application of lengthened stem hemiarthroplasty can get out of bed early, reduce the complications of bed rest, reduce the number of intraoperative fluoroscopy, and recover the function of hip joint earlier and better with satisfactory results.
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Objective To investigate the correlation between body mass index and the increase in body mass during pregnancy and adverse pregnancy outcomes in elderly pregnant women. Methods The clinical data was collected from 1,374 pregnant women who underwent regular prenatal care checkups and delivered a child at Jiangsu Maternity and Child Health Hospital from January 1, 2020 to May 1, 2020. According to the age of pregnant women, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG), the subjects were divided into different groups. The incidence of adverse pregnancy outcomes between groups was compared, and the correlation between pregnant women's age, pre-pregnancy BMI and GWG and adverse pregnancy outcomes was analyzed. Results Compared with the non-advanced age group, the elderly group had an increase in the incidence rate of gestational diabetes (GDM) (38.66% VS 19.54%), the incidence rate of large for gestational age (LGA) (LGA) (19.75% VS 14.43%), and the cesarean section rate (55.46% VS) 34.77%), and the differences between the groups were statistically significant (t=40.773, 4.270, 35.630, P=0.001, 0.039, 0.001). There were no significant differences between the non-advanced age group and the elder group in the incidence of pregnancy-induced hypertension (PIH) (10.92% VS 8.63%), the incidence of small for gestational age (2.52% VS 2.90%), and the incidence of neonatal asphyxia ( 2.10% VS 1.23%) (t=1.265, 0.105, 1.088, P=0.261, 0.746, 0.297). ). The incidence of GDM in overweight and obese elderly pregnant women was higher than that in underweight and normal pregnant women. The incidence of GDM in the elderly pregnant women with less GWG and excessive GWG was higher than that in the normal group (P<0.05). Conclusion The pre-pregnancy body mass index and the gain in body mass during pregnancy are related to the occurrence of adverse pregnancy outcomes. It is necessary to strengthen the monitoring and management of pre-pregnancy body mass index and pregnancy body quality in elderly pregnant women.
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Objective:To observe the immune factors， coagulation and curative effect of modified Shoutaiwan with Si Junzitang combined with dydrogesterone tablets in advanced age patients with early threatened abortion， and to explore its mechanism of action. Method:The 90 advanced age patients with threatened abortion and kidney deficiency and blood stasis syndrome differentiation in traditional Chinese medicine （TCM） were randomly divided into control group and observation group by random number table， with 45 cases in each group. Both groups took oral dydrogesterone tablets for luteal support. The control group additionally received natural vitamin E soft capsules by oral administration， while observation group received modified Shoutaiwan with Si Junzitang. The course of treatment was 10 days in both groups. The clinical efficacy， TCM syndrome score， immune factors and coagulation factors of the two groups were compared before and after treatment. Result:There was no statistically significant difference in TCM symptom scores， immune factors， and coagulation factors between two groups before treatment. After treatment， the scores of TCM syndromes were reduced in both groups （P<0.05）， the proportion of helper T lymphocyte （Th）， Th/Ts ratio， D-dimer （D-D） level and fibrinogen （FIB） were reduced while prothrombin time （PT） and the ratio of suppressor T lymphocyte （Ts） were increased in observation group （P<0.05）. After treatment， the proportion of Th， Th/Ts， D-D， and FIB levels in observation group were lower than those in control group， while PT and the proportion of Ts were higher than those in control group （P<0.05）. The proportion of natural killer cells （NK） had no significant change after treatment， also with no significant difference between two groups. The total effective rate was 84.4%（38/45） in observation group， higher than 64.4%（29/45） in control group （χ2=4.398，P<0.05）. There was no obvious adverse reaction in both groups during the treatment. Conclusion:Modified Shoutaiwan with Si Junzitang combined with dydrogesterone tablets can improve symptoms and the therapeutic effect for fetal protection by regulating the immune balance and coagulation function in advanced age patients with threatened abortion.
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Deterioration in overall health, hormonal disturbances, and erectile dysfunction (ED) contributes to limitations in sexual activity in the elderly, which is further limited by incorrect beliefs about the hazards of sexual activity in cardiac patients. We aimed to analyze the occurrence of ED in elderly men, their perception of the relevance of good sexual function, and their expectations of physicians. A cross-sectional study encompassed 731 patients with coronary artery disease (CAD) subjected to cardiac rehabilitation. Demographic data and data on modifiable risk factors and patient expectations were collected. ED was assessed using the IIEF-5 questionnaire. Relationships among the risk factors for ED, occurrence of ED, and patient expectations, as well as the changes in the indicators between 2012 and 2016, were analyzed. The mean age of men was 70.7 ± 5.1 years. The prevalence of ED was 93.0%. The IIEF-5 score was significantly associated with age, tobacco smoking, exercise tolerance, time to diagnosis of CAD, and treatment with calcium channel blockers and diuretics. Patients declared that sexual activity was overall important (47.9%) or very important (25.6%). Three hundred and sixty (49.3%) patients expected their physician to show interest in their sexual health, but the topic was addressed in only 12.5%. Over the past few years, we have observed an increase in the awareness and importance of sexual health as well as a significant increase in patients' expectations of physicians to show interest in their sexual health. Patients' expectations of discussing and receiving treatment for ED remain an unmet medical need.
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Introduction: As the average life expectancy is increasing, the number of patients aged >100 years who have fragility fractures will increase in the future. In female patients, the incidence of open fractures increases with age.Case Presentation: We present the case of a 102-year-old woman with open tibial and fibular diaphyseal fractures (Gustilo-Anderson classification type IIIb) treated with temporary external fixation, advancement flap, and negative pressure wound therapy in the first-stage surgery and treatment, and open reduction and internal fixation with skin grafting in the second-stage surgery. Open wound and bone healing were attained.Conclusion: Surgery should not be denied on the basis of age alone. Medical evaluation should focus on identifying risk factors, assessing risk in detail, optimizing status, predicting complications, and making the appropriate surgical plan for the patient status. Moreover, in the present case, meticulous postoperative management was the main reason for the successful surgical treatment.
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RESUMEN Introducción: El retraso diagnóstico de la infección por SIDA constituye un problema de gran magnitud con importantes repercusiones para los propios infectados y para la sociedad en general. Objetivos: Caracterizar a los pacientes con diagnóstico tardío de infección por VIH y su evolución a los 6 meses del diagnóstico. Material y Métodos: Se realizó un estudio longitudinal de corte prospectivo que incluyó 248 casos con diagnóstico positivo de infección por VIH durante su ingreso o en la consulta de infectología del Instituto de Medicina Tropical "Pedro Kourí" desde enero de 2015 hasta diciembre de 2016, los que se dividieron en dos grupos de comparación, según diagnóstico tardío (n=79) o no (n=169) de la enfermedad. Resultados: La edad avanzada y el sexo masculino fueron factores relacionados con el diagnóstico tardío de la infección por VIH. La fiebre (31,7%) y los síntomas respiratorios (20,3%) fueron las formas más frecuentes de presentación, mientras que la neumonía por Pneumocystis jirovecii fue la enfermedad con más incidencia en el momento del diagnóstico. La mitad de los pacientes se encontraban con inmunodepresión severa en el momento del diagnóstico. Los pacientes con diagnóstico tardío mostraron una supervivencia significativamente menor a los 6 meses del diagnóstico en comparación con los pacientes con diagnóstico precoz. La carga viral y el nivel de linfocitos CD4 fueron parámetros de laboratorio con un alto valor predictivo de mortalidad. Conclusiones: El diagnóstico tardío de infección por VIH conlleva un alto riesgo de mortalidad, mayor en aquellos con afectación de la carga viral y el nivel de linfocitos T CD4+.
ABSTRACT Introduction: Late diagnosis of HIV is a major problem with important consequences for the people infected with this virus and the society in general. Objectives: To characterize patients with late diagnosis of HIV infection and their evolution six months after diagnosis. Material and Methods: We conducted a prospective longitudinal study which included 248 cases with positive diagnosis of HIV infection during admission at the Pedro Kourí Tropical Medicine Institute between January 2015 and December 2016. They were divided into two comparison groups which included patients with late diagnosis (n=79) and those with no late diagnosis (n=169) of the disease. Results: Advanced age and male sex were factors related to the late diagnosis of HIV infection. Fever (31.7%) and respiratory symptoms (20.3%) were the most frequent forms of presentation, whereas Pneumocystis jirovecii pneumonia was the disease with the highest incidence at the time of diagnosis. Half of the patients were found to have severe immunosuppression at the time of diagnosis. Patients with late diagnosis showed a significantly diminished survival six months after being diagnosed compared with those patients with early diagnosis. Viral load and CD4+ T count were laboratory parameters with a high predictive value of mortality. Conclusions: Late diagnosis of HIV leads to a high risk of mortality, which is higher in those with affectation of the viral load and low CD4+ T cell count.
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A 98-year-old male patient with history of hemiarthroplasty suffered periprosthetic fracture of right femoral shaft and developed acute coronary event in three days after hospitalization. Femoral nerve and lateral femoral cutaneous nerve blocks combined with general anesthesia were implemented for the internal fixation surgery. The recovery was uneventful after discharge. In this case report, we discussed the main considerations of anesthesia specifically for this complicated case.
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Aged, 80 and over , Humans , Male , Anesthesia, General , Femoral Fractures/surgery , Periprosthetic Fractures/surgeryABSTRACT
Objective To analyze the related risk factors affecting the prognosis of elderly patients with severe community acquired pneumonia (SCAP). Methods A retrospective study method was conducted; the elderly (≥ 75 years old) patients with SCAP treated in the First Affiliated Hospital of Hainan Medical College from January 2015 to January 2019 were enrolled. The general data of patients were collected, including sex, age, oxygenation index (PaO2/FiO2), involved organs, presence or absence of following diseases or treatment: damage in multiple lung lobes, septic shock, basic diseases (cardiovascular disease, chronic lung disease, diabetes, hypertension, and cerebrovascular disease), invasive mechanical ventilation, ventilator-associated pneumonia (VAP), misinhalation event, hyponatremia, respiratory acidosis, hypoproteinemia, intubation times, total mechanical ventilation time, etc. According to the prognosis, the patients were divided into a death group and a survival group. The general data were compared between the two groups with different prognoses. Single factor analysis was carried out by selecting variables. The indicators with statistical significant differences in the results of univariate analysis were introduced into the multivariate Logistic regression analysis to analyze the related risk factors affecting the prognosis of elderly patients with SCAP. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive values of risk factors in the patients with SCAP. Results A total of 112 patients were included, 33 died, and the mortality rate was 29.46%. Univariate analysis showed that the following factors were higher in the death group than those in the survival group: organ involvement >2 [69.70% (23/33) vs. 35.44% (28/79)], lung lobe damage ≥ 3 [75.76% (25/33) vs. 51.90% (41/79)], invasive mechanical ventilation [72.73% (24/33) vs. 32.91% (26/79)], diabetes [30.30% (10/33) vs. 12.66% (10/79)], intubation times ≥2 [57.58% (19/33) vs. 48.10% (38/79)], hypoproteinemia [75.76% (25/33) vs. 41.77% (33/79)], hyponatremia [72.73% (24/33) vs. 48.10% (38/79)], respiratory acidosis [66.67% (22/33) vs. 44.30 %(35/79)] and total mechanical ventilation time ≥ 15 days [69.70% (23/33) vs. 40.51 (32/79)]; the factors in the death group lower than those in the survival group were: septic shock [3.03% (1/33) vs. 17.72% (14/79)], chronic lung disease [6.06% (2/33) vs. 25.32% (20/79)] and PaO2/FiO2 [mmHg (1 mmHg = 0.133 kPa): 102.89±14.78 vs. 109.56±14.08],the differences were statistically significant (all P < 0.05); there were no significant differences in gender, age, cardiovascular disease, hypertension, VAP, misinhalation events and cerebrovascular disease between the two groups (all P > 0.05). Multivariate Logistic regression analysis showed that diabetes mellitus [odds ratio (OR) = 1.074, 95% confidence interval (95%CI) = 1.017-1.287, P =0.045], septic shock (OR = 2.765, 95%CI = 1.083-3.411, P = 0.047), hyponatremia (OR = 1.792, 95%CI = 1.128-1.417, P = 0.006), hypoalbuminemia (OR = 2.187, 95%CI = 1.872-5.462, P = 0.046), invasive mechanical ventilation (OR = 5.870, 95%CI = 2.324-23.796, P = 0.001), respiratory acid poisoning (OR = 2.934, 95%CI = 2.454-7.275, P = 0.043), time of mechanical ventilation (OR= 1.986, 95%CI = 2.467-3.483, P = 0.034), number of intubation (OR = 6.760, 95%CI = 2.116-24.696, P = 0.001), PaO2/FiO2 (OR = 1.981, 95%CI = 1.006-1.417, P = 0.007), organ involvement > 2 (OR = 2.924, 95%CI = 2.534-6.285, P = 0.048), chronic lung disease (OR = 2.887, 95%CI = 1.487-3.483, P = 0.039), and lung lobe damage≥3 (OR = 2.754, 95%CI = 1.131-1.798, P = 0.045) were independent risk factors affecting the prognosis of elderly patients with SCAP. ROC analysis showed that hyponatremia, hypoalbuminemia, invasive mechanical ventilation, total mechanical ventilation time, PaO2/FiO2, organ involvement > 2, damage of lung lobes ≥ 3, had predictive values for the prognosis of SCAP [the areas under ROC curve (AUC) were 0.377, 0.267, 0.301, 0.646, 0.650, 0.329, and 0.381, respectively, all P < 0.05]. Conclusions Underlying disease, invasive mechanical ventilation, respiratory acidosis, total mechanical ventilation time, PaO2/FiO2, intubation times ≥ 2, chronic lung disease and lung damage≥ 3 lobes are the independent risk factors for the prognosis of elderly patients with severe community acquired pneumonia. Clinical treatment should focus on the above aspects to minimize the mortality of patients.
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Objective@#To investigate the timing of the laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute pyogenic cholecystitis in the advanced age.@*Methods@#The clinical data for 56 advanced age patients with acute pyogenic cholecystitis in the Department of Hepatobiliary Surgery, the 900th Hospital of the Joint Logistics Support Force of People′s Liberation Army from January 2018 to February 2019 were retrospectively analyzed. There were 31 males and 25 females, aged from 70 to 86 years, with average age was (75.52±3.57) years. According to the percutaneous transhepatic gallbladder drainage(PTGD) after laparoscopic cholecystectomy(LC) time interval, all patients were divided into three groups. Patients in the group A(n=12), B(n=21), and C (n=23) performed LC were within 2 months, during 2-4 months, and during 4-6 months, retrospectively. Observation indicators: (1) Surgical situations. The operation and postoperative basic condition of the three groups were compared. (2) Follow-up situations. Patients were followed-up by outpatient examination or telephone interview to detect the postoperative complication in the postoperative three months up to June 2019. Measurement data with normal distribution were represented as (Mean±SD), and comparison multiple groups was done using single factor analysis of variance (AVONA test) , and comparison between groups was done using the t test, and comparison of multiple groups in pairs was done using the SNK-q test, and hierarchical data were analyzed using Kruskal-wallis H test. Count data were analyzed using the chi-square test or Fisher exact probability.@*Results@#(1) Surgical situations: the thickness of gallbladder wall before LC, the rates of converting to laparotomy, the volume of intraoperative blood loss, the operation duration, and the duration of postoperative hospital stay were (0.57±0.04) cm, 50.0%, (95.83±11.45) ml, (107.50±21.90) min, (5.67±3.40) d in the group A, and (0.43±0.03) cm, 9.5%, (69.52±24.59) ml, (71.43±12.16) min, (3.76±2.61) d in the group B, and (0.43±0.05) cm, 39.1%, (68.64±21.89) ml, (77.95±12.88) min, (5.05±2.95) d in the group C, respectively, showing significant differences in the above indicators between the three groups (P<0.05). The thickness of gallbladder wall before LC, the volume of intraoperative blood loss, the operation duration, those in group A were higher than the group B and C (P<0.05), and with no statistically significant different between the group B and C (P>0.05). The rates of converting to laparotomy, the duration of postoperative hospital stay in group B were better than the group A and C (P<0.05), and with no statistically significant different between the group A and C (P>0.05). The thickness of gallbladder wall before LC, the volume of intraoperative blood loss, the operation duration, and the duration of postoperative hospital stay were (0.43±0.03) cm, (46.67±9.82) ml, (67.69±7.77) min, (2.64±0.58) d in the gallbladder wall thickness of successful LC patients, and (0.52±0.04) cm, (123.53±17.30) ml, (134.12±25.51) min, (8.47±0.80) d in the laparotomy patients, respectively, showing significant differences in the above indicators between the two groups (P<0.05). (2) Follow-up situations: 56 patients were followed up and without perioperative death. No complications occurred after 3 months of follow-up.@*Conclusion@#Elective surgery that is performed in 2-4 months after PTGD for patients with acute pyogenic cholecystitis in the advanced age can reduce the volume of intraoperative blood loss and the rates of converting to laparotomy, shorten the operation duration and the duration of postoperative hospital stay, which is beneficial to the recovery of patients.
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Objective To investigate the timing of the laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute pyogenic cholecystitis in the advanced age.Methods The clinical data for 56 advanced age patients with acute pyogenic cholecystitis in the Department of Hepatobiliary Surgery,the 900th Hospital of the Joint Logistics Support Force of People's Liberation Army from January 2018 to February 2019 were retrospectively analyzed.There were 31 males and 25 females,aged from 70 to 86 years,with average age was (75.52±3.57) years.According to the percutaneous transhepatic gallbladder drainage(PTGD) after laparoscopic cholecystectomy(LC) time interval,all patients were divided into three groups.Patients in the group A(n =12),B (n =21),and C (n =23) performed LC were within 2 months,during 2-4 months,and during 4-6 months,retrospectively.Observation indicators:(1) Surgical situations.The operation and postoperative basic condition of the three groups were compared.(2) Follow-up situations.Patients were followed-up by outpatient examination or telephone interview to detect the postoperative complication in the postoperative three months up to June 2019.Measurement data with normal distribution were represented as (Mean ± SD),and comparison multiple groups was done using single factor analysis of variance (AVONA test),and comparison between groups was done using the t test,and comparison of multiple groups in pairs was done using the SNK-q test,and hierarchical data were analyzed using Kruskal-wallis H test.Count data were analyzed using the chi-square test or Fisher exact probability.Results (1) Surgical situations:the thickness of gallbladder wall before LC,the rates of converting to laparotomy,the volume of intraoperative blood loss,the operation duration,and the duration of postoperative hospital stay were (0.57±:0.04) cm,50.0％,(95.83 ±11.45) ml,(107.50±21.90) min,(5.67±3.40) d in the group A,and (0.43 ±0.03) cm,9.5％,(69.52±24.59) ml,(71.43 ±12.16) min,(3.76±2.61) d in the group B,and (0.43 ± 0.05) cm,39.1％,(68.64 ±21.89) ml,(77.95 ±12.88) min,(5.05 ±2.95) d in the group C,respectively,showing significant differences in the above indicators between the three groups (P ＜ 0.05).The thickness of gallbladder wall before LC,the volume of intraoperative blood loss,the operation duration,those in group A were higher than the group B and C (P ＜0.05),and with no statistically significant different between the group B and C (P ＞ 0.05).The rates of converting to laparotomy,the duration of postoperative hospital stay in group B were better than the group A and C (P ＜ 0.05),and with no statistically significant different between the group A and C (P ＞0.05).The thickness of gallbladder wall before LC,the volume of intraoperative blood loss,the operation duration,and the duration of postoperative hospital stay were (0.43 ± 0.03) cm,(46.67 ± 9.82) ml,(67.69 ± 7.77) min,(2.64 ±0.58) d in the gallbladder wall thickness of successful LC patients,and (0.52±0.04) cm,(123.53 ±17.30) ml,(134.12±25.51) min,(8.47 ±0.80) d in the laparotomy patients,respectively,showing significant differences in the above indicators between the two groups (P ＜ 0.05).(2) Follow-up situations:56 patients were followed up and without perioperative death.No complications occurred after 3 months of follow-up.Conclusion Elective surgery that is performed in 2-4 months after PTGD for patients with acute pyogenic cholecystitis in the advanced age can reduce the volume of intraoperative blood loss and the rates of converting to laparotomy,shorten the operation duration and the duration of postoperative hospital stay,which is beneficial to the recovery of patients.
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Objective To study the characteristics of ambulatory blood pressure in advanced age patients with hypertension during pregnancy and its effect on pregnancy outcome, and to explore the clinical significance of ambulatory blood pressure monitoring in advanced age women with hypertension.Methods A retrospective analysis from January 2016 to August 2017, in patients with pregnancy induced hypertension in the Second Affiliated Hospital of Kunming Medical University of production inspection and delivery in hospital as the research object, according to the age of pregnant women, they were divided into the advanced age group (35 years of age or older, n=100), and age group (age ＜35, n=100). All the pregnant women underwent 24-hour ambulatory blood pressure examination in the middle and third trimester of pregnancy to compare the difference of ambulatory blood pressure parameters between the two groups and the relationship between them and the adverse outcome of pregnancy. Results Systolic pressure index of the advanced age group 24 hours average systolic pressure, day mean systolic pressure, night mean systolic pressure, day systolic pressure load value, night systolic pressure load value were higher than the age group, the differences were statistically significant (P＜0.05); The incidences of cesarean section and premature infant were higher than thase in the age group, and the differences were was statistically significant (P＜0.05). The average diastolic blood pressure andthe day systolic load were correlated with fetal growth restriction in both the aged and age groups, and the24-hour mean diastolic blood pressure was associated with preterm infants. Conclusions Ambulatory blood pressure monitoring has a positive significance in the diagnosis, evaluation and reduction of adverse pregnancy outcomes in the advanced age patients with hypertensive pregnancy, and can be used as prenatal routine examination for the advanced age pregnant women.
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Objectives:To describe the early and long-term survival of off-pump coronary artery bypass grafting(OPCAB)and to analyze the impact and risk factors of peri-operative events on mortality and long-term survival in OPCAB patients aged over 75 years old. Methods:From January 2001 to December 2012,233 patients aged over 75 underwent OPCAB in our hospital, 173 cases (74.25%) were male,the average age was (77.1±2.3) years.The perioperative data was retrospectively collected.Binary Logistic regression was used to define the risk factors related to the perioperative events and mortality.Follow-up was performed regularly post-surgery. Univariate analysis and Cox regression model were used to find out factors affecting the long-term outcomes. Results:Fifteen out of 233 patients died during the perioperative period. Binary Logistic regression showed that preoperative arrhythmia (OR=6.767, P=0.002),IABP ( intraoperative, post-operative) (OR=4.292, P=0.040;OR=19.455, P＜0.001), ICU stay time (OR=1.500, P=0.001), mechanical ventilation time (OR=1.004, P=0.002), reintubation or tracheotomy (OR=30.000, P＜0.001), re-thoracotomy (OR=26.750, P＜0.001), postoperative cerebral infarction (OR=5.889, P=0.041) were risk factors of perioperative mortality. The remaining 218 patients were followed up for a mean of (92.84±45.52) months, 121 patients died during follow-up. The survival rate at l, 3, 5, 8 and 10 years was 90.99%, 87.55%, 85.31%, 68.93% and 56.70%, respectively. Univariate analysis showed that sex(male), hypertension, preoperative arrhythmia, reintubation or tracheotomy were risk factors of the long-term mortality (P＜0.05). Cox regression analysis showed that reintubation or tracheotomy (HR 4.387, 95%CI=1.876-10.259,P＜0.010) was the independent risk factor affecting the long-term survival. Conclusions:Preoperative arrhythmia, IABP (intraoperative, postoperative), ICU stay time, mechanical ventilation time, reintubation and tracheotomy, re-thoracotomy, postoperative cerebral infarction are risk factors of perioperative mortality. Reintubation or tracheotomy is the independent risk factor affecting the long-term survival.Taken together, OPCAB in patients aged over 75 is associated with favorable perioperative and long-term outcome,and it serves a safe and effective operative strategy for coronary artery revascularization in patients aged over 75.
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This study aimed to explore the outcomes of progestin-primed ovarian stimulation protocol (PPOS) in aged infertile women who failed to get pregnant in the first IVF/ICSI-ET cycles with GnRH-a long protocol.A self-controlled study was conducted to retrospectively investigate the clinical outcomes of 104 aged infertile patients who didn't get pregnant in the first IVF/ICSI-ET treatment by stimulating with GnRH-a long protocol (non-PPOS group),and underwent PPOS protocol (PPOS group) in the second cycle between January 2016 and December 2016 in the Center for Reproductive Medicine,Renmin Hospital of Wuhan University.The primary outcomes included clinical pregnancy rate of frozen-thawed embryos transfer (FET) in PPOS group,and good-quality embryo rate in both groups.The secondary outcomes were fertilization rate,egg utilization rate and cycle cancellation rate.The results showed that there were no significant differences in basal follicle stimulating hormone (bFSH),antral follicle count (AFC),duration and total dosage of gonadotropin (Gn),number of oocytes retrieved,intracytoplasmic sperm injection (ICSI) rate,fertilization rate,and cycle cancellation rate between the two groups (P＞0.05).However,the oocyte utilization rate and good-quality embryo rate in PPOS group were significantly higher than those in non-PPOS group (P＜0.05).By the end of April 2017,62 FET cycles were conducted in PPOS group.The clinical pregnancy rate and embryo implantation rate were 22.58％ and 12.70％,respectively.In conclusion,PPOS protocol may provide better clinical outcomes by improving the oocyte utilization rate and good-quality embryo rate for aged infertile patients who failed to get pregnant in the first IVF/ICSI-ET cycles.
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This study aimed to explore the outcomes of progestin-primed ovarian stimulation protocol (PPOS) in aged infertile women who failed to get pregnant in the first IVF/ICSI-ET cycles with GnRH-a long protocol.A self-controlled study was conducted to retrospectively investigate the clinical outcomes of 104 aged infertile patients who didn't get pregnant in the first IVF/ICSI-ET treatment by stimulating with GnRH-a long protocol (non-PPOS group),and underwent PPOS protocol (PPOS group) in the second cycle between January 2016 and December 2016 in the Center for Reproductive Medicine,Renmin Hospital of Wuhan University.The primary outcomes included clinical pregnancy rate of frozen-thawed embryos transfer (FET) in PPOS group,and good-quality embryo rate in both groups.The secondary outcomes were fertilization rate,egg utilization rate and cycle cancellation rate.The results showed that there were no significant differences in basal follicle stimulating hormone (bFSH),antral follicle count (AFC),duration and total dosage of gonadotropin (Gn),number of oocytes retrieved,intracytoplasmic sperm injection (ICSI) rate,fertilization rate,and cycle cancellation rate between the two groups (P＞0.05).However,the oocyte utilization rate and good-quality embryo rate in PPOS group were significantly higher than those in non-PPOS group (P＜0.05).By the end of April 2017,62 FET cycles were conducted in PPOS group.The clinical pregnancy rate and embryo implantation rate were 22.58％ and 12.70％,respectively.In conclusion,PPOS protocol may provide better clinical outcomes by improving the oocyte utilization rate and good-quality embryo rate for aged infertile patients who failed to get pregnant in the first IVF/ICSI-ET cycles.
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Objective To investigate the clinical characteristics and risk factors of the incidence of herpes zoster after renal transplantation. Methods Clinical data of 830 recipients undergoing renal transplantation for the first time in the Organ Transplantation Research Institute of the 309th Hospital of Chinese People's Liberation Army from March 2009 to March 2012 were retrospectively analyzed. Univariate and multivariate Logistic regression analyses were performed to identify the risk factors of the incidence of herpes zoster after renal transplantation. Results Among 830 patients, 42 (5.1%) suffered from herpes zoster postoperatively. Clinical manifestations of herpes zoster mainly included varicella-zoster rash in the head, face, trunk and limbs. No patient died from herpes zoster. Post-herpetic neuralgia (PHN) was the most common complication of herpes zoster. Univariate Logistic regression analysis revealed that advanced age and adrenal cortical hormone (hormone) shock therapy could increase the risk of herpes zoster viral infection after renal transplantation (OR=2.414, P=0.016; OR=2.936, P=0.003). Multivariate Logistic regression analysis demonstrated that advanced age and hormone shock therapy were the independent risk factor of the incidence of herpes zoster following renal transplantation (OR=2.238, P=0.030; OR=2.755, P=0.005). Conclusions Herpes zoster after renal transplantation is clinically manifested with varicellazoster rash. Advanced age and hormone shock therapy are the independent risk factor of the incidence of herpes zoster after renal transplantation.
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Objective To determine the efficacy of cemented hemiprosthetic hip joint arthroplasty in comparison with proximal femoral nail antirotation (PFNA) applied to femoral intertrochanteric fracture in elderly patients.Methods This retrospective analysis consisted of 58 patients with intertrochanteric fracture who underwent cemented hemiprosthetic hip joint arthroplasty and PFNA who were admitted between January 2010 and December 2014 in No.202 Hospital of PLA.Their operative time,bleeding volume,postoperative drainage volume,and joint function scores were compared.Results The cemented hemiprosthetic hip joint arthroplasty group had shorter operative time than the PFNA group,but the PFNA group had better Harris scores for joint function in the first month after operation and the last follow-up.Intraoperative hemorrhage and postoperative drainage were exceedingly high in the PFNA group.Conclusion Both therapies can be used to manage intertrochanteric fracture in elderly patients effectively.PFNA is mostly applied in patients with more-basic defects,worse physical conditions,worse tolerance to surgeries,and lighter osteoporosis,whereas cemented hemiprosthetic hip joint arthroplasty is more suitable for patients with less severe physical defects,more severe osteoporosis,and better physical conditions.
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Objective·To investigate safety of laparoscopic surgery in diagnosis and treatment of gynecologic diseases in elderly women over 70 years old. Methods·A total of 420 cases of elderly patients over 70 years old from January 2009 to December 2016 were retrospectively analyzed in Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. According to ages, the patients were divided into elderly group (70-80 years old,including 70 years old) and advanced age group (80 years old and above); according to surgical methods, the patients were divided into laparoscopy group and laparotomy group. The ages, American Society of Anesthesiology (ASA) classifications, body mass indexes (BMI), preoperative complications, surgical methods, intraoperative circumstances, postoperative pathology results and postoperative complications were analyzed. Results·There were no significant differences in age, ASA classification and BMI between laparoscopy group and laparotomy group in the same age group (P<0.05). Most patients had various chronic diseases before operations. Taking total hysterectomy as an example, laparoscopy groups in the two age groups were superior to laparotomy groups in the comparison of surgical time, bleeding volume, anal evacuation time and length of hospital stay (P<0.05). In the two age groups,laparoscopic malignant tumor radical surgery took less time, less bleeding and shorter anal evacuation time than laparotomy (P<0.05). Elderly laparoscopy group had less poor wound healing cases than elderly laparotomy group (P<0.05), while there was no statistical difference in other postoperative complications (P>0.05). All the patients completed the surgeries without perioperative deaths. Conclusion·Laparoscopy is safe in the diagnosis and treatment of gynecological benign and malignant diseases in elderly women with shorter operation time, less bleeding and faster postoperative recovery compared with laparotomy.