RÉSUMÉ
Objective To investigate the clinical value of enhanced recovery after surgery (ERAS) in patients undergoing postoperative early enteral nutrition (EEN) with radical resection for hilar cholangiocarcinoma.Methods The clinical data of 48 patients with hilar cholangiocarcinoma who were admitted to the Drum Tower Clinical Medical College of Nanjing Medical University from July 2006 to September 2014 were retrospectively analyzed.All the 48 patients underwent radical resection for hilar cholangiocarcinoma,including 24 patients receiving postoperative EEN (EEN group) and 24 patients receiving total parenteral nutrition (TPN group).The serologic indices and liver function were detected regularly after operation.Ten percent of albumin (Alb) 10 g was administered by intravenous infusion when Alb ＜ 30 g/L.The indexes of all the 48 patients were compared in the 2 groups at postoperative day 3 and 7,including the serologic indices and liver function,the exhaust time,the volume of Alb infusion,the complications (incisional infection,abdominal infection,pleural effusion,peritoneal effusion and bile leakage) and the duration of hospital stay.The patients were followed up by outpatient examination and telephone interview till September 2014.The measurement data with normal distribution were presented as x ± s,comparison between groups and count data were analyzed using the t test and chi-squared test,respectively.Results Patients in the 2 groups were cured successfully and discharged,and no patient died perioperatively.Patients in the EEN group had a good tolerance for EEN and no occurrence of EEN-related complications was detected.The level of the GGT was (108 ± 73) U/L in the EEN group,which was significantly lower than (225 ± 121) U/L in the TPN group at postoperative day 3 (t =4.041,P ＜ 0.05).The level of the GGT was (142 ± 86) U/L in the EEN group,which was no significantly different from (183 ± 107)U/L in the TPN group at postoperative day 7 (t =1.477,P ＞ 0.05).The postoperative time to anal exsufflation and the duration of hospital stay were (73 ± 18) hours and (15 ± 4) days in the EEN group,which were significantly different from (97 ± 21) hours and (18 ± 4) days in the TPN group,and the volume of Alb infusion was (44 ± 29)g in the EEN group,which was significantly lower than (101 ± 92) g in the TPN group (t =4.295,2.615,2.916,P ＜ 0.05).All the 48 patients were followed up for 1 to 71 months (mediantime,10 months),no patients received reoperation or re-admitted to the hospital due to complications.Conclusion The application of postoperative EEN in enhanced recovery of patients undergoing radical resection for hilar cholangiocarcinoma is safe and effective,it could accelerate the recovery of enteral function,shorten the postoperative duration of hospital stay and reduce the supplement of extrinsic Alb,which is helpful for the fast recovery of patients.
RÉSUMÉ
Objective To explore the clinical features, treatment and outcome of puerperium pulmonary thromboembolism (PTE). Methods To count the cases of spontaneous labor and cesarean section, as well as the incidence of PTE, treated in the First Affiliated Hospital of Guangzhou Medical University from Jan. 2006 to Nov. 2011, and retrospectively analyze the data of hospitalized parturients with PTE. Results A total of 5052 cases of spontaneous delivery were collected at the obstetric ward, of which 2910 cases (57.6%) were cesarean sections and 2142 cases (42.4%) were vaginal delivery. On the duration of hospital stay, 13 cases (0.26%) were diagnosed as puerperal PTE by CT pulmonary angiography, of which 11 cases occurred within 3 days after delivery. The incidence of puerperal PTE was significantly higher in cases with cesarean section than in those with vaginal delivery (0.38% vs 0.09%, P=0.043). The most common symptoms of puerperal PTE were breathless (76.9%), cough (53.8%), pleuritic chest pain (23.1%) and fever (30.8%). The clinical symptoms were improved by anticoagulation therapy (11 cases) or thrombolysis (2 cases) with zero mortality. Conclusions The incidence of puerperal PTE in the hospital the authors served is 0.26%. Puerperal PTE should be considered especially to those parturients with sudden dyspnea, chest tightness or pleuritic chest pain within 3 days after cesarean section.
RÉSUMÉ
Tuberculosis (TB) is endemic in China with high prevalence of multiple-drug resistant tuberculous bacilli (MDRTB). The incidence of new cases of TB reaches 1,300 thousand annually. Among them, 5.7 percent are MDR-TB. Staining for acidfast bacilli in sputum and clinicoradiological examination have been the main diagnostic tools for TB, particularly pulmonary TB. However, the positive rate of sputum Ziehl-Neelsen stain for sputum is disappointedly low, merely 28% in newly-diagnosed TB. Moreover, the radiological manifestations of the patients suspected of TB are often non-specific. All these facts call for a simple, accurate and rapid diagnostic method to overcome this bottleneck, which hinders the success of satisfactory TB control in China. Employing both hemi-nested RT-PCR and beacon technology with fluorescent probes, the MTB/RIF diagnostic assay specifically amplifies, thus helps detect the rpoB gene, which is unique to Mycobacterium tuberculosis and also a biomolecularmarker of rifampin resistance. As a semi-quantitative analysis, the quantity of Mycobacterium tuberculosis in samples is reflected by the threshold of PCR cycles during MTB/RIF assay. With Mycobacterium tuberculosis culture as the standard reference, for sputum samples from patients suspected of suffering from pulmonary TB, overall diagnostic sensitivity of MTB/RIF assay is 73.1%-90.0% with a specificity of 99.0%-99.5%. For detection of rpoB gene mutations responsible for rifampin-resistance, the sensitivity is 97.2% and specificity is 98.3%. Following sample loading, the system can automatically complete the diagnostic process and report the results within 2 hours. Targeting the rpoB gene specifically, there is no cross-reaction with non-tuberculosis mycobacteria or other common respiratory pathogens. In addition to sputum samples, the system can be used to detect Mycobacterium tuberculosis in various body fluids (including pleural effusion, urine, cerebrospinal fluid and even bronchoalveolar lavage fluid) and lung tissue biopsy samples. As for sensitivity, the assay is comparable to Mycobacterium tuberculosis culture (for the latter, mean interval between loading and result-reporting is 16 or 30 days (depending upon the culture medium used), and it is 100 times longer than Ziehl-Neelsen stains. Compared with conventional laboratory diagnostic approaches, this assay is much simpler and biohazardous aerosol-free.
RÉSUMÉ
Tuberculosis (TB) is endemic in China with high prevalence of multiple-drug resistant tuberculous bacilli (MDRTB). The incidence of new cases of TB reaches 1,300 thousand annually. Among them, 5.7 percent are MDR-TB. Staining for acidfast bacilli in sputum and clinicoradiological examination have been the main diagnostic tools for TB, particularly pulmonary TB. However, the positive rate of sputum Ziehl-Neelsen stain for sputum is disappointedly low, merely 28% in newly-diagnosed TB. Moreover, the radiological manifestations of the patients suspected of TB are often non-specific. All these facts call for a simple, accurate and rapid diagnostic method to overcome this bottleneck, which hinders the success of satisfactory TB control in China. Employing both hemi-nested RT-PCR and beacon technology with fluorescent probes, the MTB/RIF diagnostic assay specifically amplifies, thus helps detect the rpoB gene, which is unique to Mycobacterium tuberculosis and also a biomolecularmarker of rifampin resistance. As a semi-quantitative analysis, the quantity of Mycobacterium tuberculosis in samples is reflected by the threshold of PCR cycles during MTB/RIF assay. With Mycobacterium tuberculosis culture as the standard reference, for sputum samples from patients suspected of suffering from pulmonary TB, overall diagnostic sensitivity of MTB/RIF assay is 73.1%-90.0% with a specificity of 99.0%-99.5%. For detection of rpoB gene mutations responsible for rifampin-resistance, the sensitivity is 97.2% and specificity is 98.3%. Following sample loading, the system can automatically complete the diagnostic process and report the results within 2 hours. Targeting the rpoB gene specifically, there is no cross-reaction with non-tuberculosis mycobacteria or other common respiratory pathogens. In addition to sputum samples, the system can be used to detect Mycobacterium tuberculosis in various body fluids (including pleural effusion, urine, cerebrospinal fluid and even bronchoalveolar lavage fluid) and lung tissue biopsy samples. As for sensitivity, the assay is comparable to Mycobacterium tuberculosis culture (for the latter, mean interval between loading and result-reporting is 16 or 30 days (depending upon the culture medium used), and it is 100 times longer than Ziehl-Neelsen stains. Compared with conventional laboratory diagnostic approaches, this assay is much simpler and biohazardous aerosol-free.
RÉSUMÉ
Objecfive To investigate the association between bacteriology of airway secretions in acute onset chronic respiratory failure (ACRF) and its clinical prognosis.Methods The bacterial flora and antibiotic resistance in the airway secretions from 44 patients with 49 cases of ACRF were studied,the associations between bacteriology,antibiotic resistance and annual ACRF hospital admission frequency (ACRF≥2 or ACRF<2),its mortality were also explored.Results Positive rate of culture in airway secretions was 63.3%.Untraditional pathogens such as Pseudomonas Aeruginosa accounted for 80.7%.The bacterial yield of patients with ACRF≥2 was twice as that with ACRF<2 (P<0.01).Of the identified bacteria,61.3% displayed antibioticresistance,and there was signifi-cant prolongation of ventilation and hospitalization and increase of mortality in patients with antibiotic resistance(P<0.05).Conclusion There is a predominance of untraditional pathogens such as Pseudomonas Aeruginosa in bacteria from airway secretions of ACRF patients,positive yield and percentage of untraditional pathogens increased with the severity of chronic respiratory failure,infections caused by antibiotic-resistant strains led to higher mortality in ACRF.