The efficacy of microsurgical clipping treatment for intracranial aneurysm rupture and optimal timing research / 中国基层医药

Objective@#To study the clinical efficacy of microsurgical clipping treatment for intracranial aneurysm rupture and optimal timing.@*Methods@#From January 2016 to December 2017, 80 patients with intracranial aneurysm rupture in Taizhou Enze Medical Center(Group) Hospital were randomly divided into the control group (24-72h after rupture) and the observation group (within 24h after rupture) according to the digital table, with 40 patients in each group.The pre- and intra-surgical re-rupture and surgical clipping, post-surgical complications, and clinical efficacy of 6-month follow-up in the two groups were observed and compared.@*Results@#Compared with the control group, the incidence rate of pre-surgical re-rupture was significantly reduced in the observation group (0.0% vs.10.0%, χ2=4.21, P<0.05). Compared with the control group, the incidence rate of post-surgical complications was obviously reduced in the observation group (20.0% vs.42.5%, χ2=4.71, P<0.05). Compared with the control group, the excellent rate of treatment was significantly improved in the observation group (87.5% vs.65.0%, χ2=5.59, P<0.05).@*Conclusion@#The microsurgical clipping treatment can improve the clinical efficacy of intracranial aneurysm rupture and sooner surgery with better prognosis.

The efficacy of microsurgical clipping treatment for intracranial aneurysm rupture and optimal timing research / 中国基层医药

To study the clinical efficacy of microsurgical clipping treatment for intracranial aneurysm rupture and optimal timing.Methods From January 2016 to December 2017,80 patients with intracranial aneurysm rupture in Taizhou Enze Medical Center ( Group) Hospital were randomly divided into the control group (24-72h after rupture) and the observation group (within 24h after rupture) according to the digital table,with 40 patients in each group.The pre-and intra-surgical re-rupture and surgical clipping ,post-surgical complications, and clinical efficacy of 6-month follow-up in the two groups were observed and compared.Results Compared with the control group,the incidence rate of pre -surgical re-rupture was significantly reduced in the observation group (0.0%vs.10.0%,χ2 ＝4.21,P＜0.05).Compared with the control group ,the incidence rate of post -surgical complications was obviously reduced in the observation group (20.0%vs.42.5%,χ2 ＝4.71,P＜0.05).Compared with the control group ,the excellent rate of treatment was significantly improved in the observation group (87.5%vs. 65.0%,χ2 ＝5.59,P＜0.05).Conclusion The microsurgical clipping treatment can improve the clinical efficacy of intracranial aneurysm rupture and sooner surgery with better prognosis.

Operation timing of laparoscopic cholecystectomy in mild acute billiary pancreatitis / 中华胰腺病杂志

Objective To explore the operation timing of laparoscopic cholecystectomy ( LC ) for patients with first onset of mild acute biliary pancreatitis ( ABP) . Methods From January 2012 to December 2017, a total of 905 ABP patients who admitted to the First Affiliated Hospital of Soochow University were retrospectively assessed. Among them, 165 ABP patients underwent LC. According to the different operation time after hospitalization, the patients were divided into 5 groups: within 2 weeks surgery group, 2-4 weeks surgery group, 4 -8 weeks surgery group, 8 -24 weeks surgery group and 24 weeks later surgery group. Surgery difficulty, postoperative recovery, total hospitalization time and recurrence of acute biliopancreatic disease before surgery were compared between the 5 groups. Results LC was successfully completed in all 165 patients. There was no statistically significant difference on the surgical difficulty and postoperative recovery among the 5 groups (P>0. 05). The total hospitalization time of within 2 weeks surgery group and 2-4 weeks surgery group was significantly shortened compared with that in 4-8 weeks surgery group, 8-24 weeks surgery group and 24 weeks later surgery group [14.5(8.0-21.0)d, 14.0(7.0-23.0)d]vs [17.0 (6.0-42.0)d, 20.0(9.0-46.0)d, 21.5(7.0-42.0)d], and the difference was statistically significant (P<0. 05). Moreover, the recurrence rate of acute biliopancreatic disease was 0 in within 2 weeks surgery group while waiting for surgery, which was lower than those of other four groups [6. 1％(2/33),38. 5％(15/39),61.5％(24/39),77.3％(17/22)], and the difference was statistically significant (P<0.05). Conclusions For ABP patients with first onset, LC was safe and feasible within 2 weeks after conservative treatment, which can significantly shorten the total hospitalization time and reduce the recurrence rate of acute biliopancreatic diseases during the waiting period.

Research advance of optimal timing for early enteral nutrition on severe acute pancreatitis / 国际外科学杂志

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

Research advance of optimal timing for early enteral nutrition on severe acute pancreatitis / 国际外科学杂志

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

Effect of optimal timing of internal fixation on postoperative complications in multiple rib fracture patients / 第二军医大学学报

Objective To explore the effect of optimal timing of internal fixation on postoperative complications of multiple rib fractures. Methods A total of 31 cases of multiple rib fractures receiving internal fixation in our hospital from Mar. 2014 to Jul. 2016 were included in this study. According to the time from injury to internal fixation, the patients were divided into early operation group (≤72 h, n=17) and routine operation group (>72 h, n=14). The clinical data of the patients were compared between the two groups, including age, gender, body mass index (BMI), number of fractured ribs, incidence of comorbidity, incidence of postoperative complications and pain improvement rate. Results There were no significant differences in age, gender, BMI, number of fractured ribs, or incidence of comorbidity between the two groups (all P>0.05). The time from injury to internal fixation was significantly less in the early operation group than that in the routine operation group ([2.2±1.5] d vs [7.4±2.8] d, P0.05). Conclusio Early internal fixation surgery (≤72 h) may contribute to reducing incidence of postoperative pulmonary infection and atelectasis of the patients with multiple rib fracture.

The clinical data used for conventional indications of initiating renal replacement therapy and for predicting the prognosis of critically ill patients with acute kidney injury / 中华急诊医学杂志

Objective To investigate the value of clinical data used for conventional indications of initiating renal replacement therapy (RRT) such as serum creatinine (SCr),blood urea nitrogen (BUN) and acute renal injury (AKI) stage and in estimating the prognosis of critically ill patients with AKI.Methods A retrospective analysis of 258 AKI adult inpatients treated with continuous renal replacement therapy (CRRT) in ICU from Jan.2011 to Jan.2015.According to the outcomes,all subjects were divided into survival group (n =104)and death group (n =154).The general condition,AKI causes,results of renal function (urine output,SCr,BUN and AKI stage),homeostasis (acid-base balance and electrolyte level),severity of disease (APACHE Ⅱ score and SOFA score) and others were compared between two groups.Additionally,risk factors for the prognosis of critically ill patients with AKI were screened by the multivariate Cox's proportional hazard models and the receiver operating characteristic (ROC) curve.Results There were no significant differences in gender,age,primary disease,AKI causes,APACHE Ⅱ score,renal function (urine output,SCr,BUN and AKI stage),serum potassium level and phosphorus level between two groups before CRRT (P ＞ 0.05),but more patients in death group had severe sepsis (31.17％ vs.19.23％,P =0.033),lower pH value [(7.27 ±0.34)vs.(7.41 ±0.34),P =0.024] and higher level of lactate [(3.97 ±2.87) vs.s (2.64 ± 2.30),P =0.006].After the analysis with multivariate Coxg proportional hazard models,it was found that the levels of serum phosphorus (P =0.043) and lactate (P =0.009) were the independent risk factors for prognosis of critically ill patients with AKI,and other conventional indications for initiating RRT such as SCr,BUN,AKI stage,urine output,pH,bicarbonate level or potassium level were not closely associated with the prognosis of patients (P ＞ 0.05).Therefore,a composite of these six variables (pH,bicarbonate level,phosphorus level,potassium level,urine output and AKI stage) was analyzed.According to the analysis result of ROC curve,the diagnostic value of combined six different variables in predicting in-hospital mortality of AKI patients [area under the curve (AUC) 0.669,95％ CI:0.577-0.762] was almost as high as that of lactate (AUC:0.683,95％ CI:0.590-0.777),and significantly higher than SCr (AUC:0.460,95％ CI:0.358-0.562),BUN (AUC:0.469,95％ CI:0.366-0.571).Conclusions This composite of six different variables is more useful than any other conventional indications for initiating RRT in predicting post-AKI mortality.As a result,a composition of six different variables should be considered rather than any single variable alone for indication of initiating RRT in critically ill patients with AKI.

Current concept of congenital cleft palate repair / Монголын Анагаах Ухаан

Learning objectives: After reading this article, readers should be able to:1. Get information about brief historical aspects of the cleft palate treatment;2. Understand techniques used to repair various types of the cleft palate;3. Understand the optimal timing of the cleft palate repair;4. Understand the results and complications following palate repair including speech, maxillary growth, and fistula formation, regarding with operative techniques and timing of palatoplasty.Summary: Cleft palate is more common congenital anomaly, but surgeons have been eluding surgical correction of the cleft palate for centuries. Many surgical techniques have been described during last two centuries, the goals of these include separating the nasal and oral cavities (avoiding fistulas), establishing normal speech, and preserving maxillofacial growth. This article reviews the brief historical aspects of the cleft palate, palatoplasty techniques, the optimal timing, and the results and complication associated with palate repair technique and timing.

Optimal Timing of Surgery of Mitral Regurgitation / 한양의대학술지

Mitral regurgitation is a progressive disease that may lead to left ventricular dysfunction. Medical treatment is of limited value in chronic progressive mitral regurgitation except in those with comorbid hypertension or LV dysfunction. Recent advances in surgical techniques has changed the roles of medical and surgical therapies. Therefore the prime importance of treating physicians is to identify the optimal timing ofsurgery in this population. Two important factors should be taken into consideration while deciding the optimal timing of surgical intervention. One is functional cardiac status and the other is the left ventricular response to volume overload. Besides, the pathologic nature of mitral regurgitation, the severity of mitral regurgitation, the possibility of successful mitral repair, the development of atrial fibrillation and the presence of pulmonary hypertension, together with the hemodynamic response to exercise. Advances in the understanding of natural pathophysiologic nature of progressive mitral regurgitation and successful technical surgical repair have extended the role of early surgical intervention even in asymptomaticpatients with normal LV function.

Optimal Timing of Surgery of Mitral Regurgitation / 한양의대학술지

Mitral regurgitation is a progressive disease that may lead to left ventricular dysfunction. Medical treatment is of limited value in chronic progressive mitral regurgitation except in those with comorbid hypertension or LV dysfunction. Recent advances in surgical techniques has changed the roles of medical and surgical therapies. Therefore the prime importance of treating physicians is to identify the optimal timing ofsurgery in this population. Two important factors should be taken into consideration while deciding the optimal timing of surgical intervention. One is functional cardiac status and the other is the left ventricular response to volume overload. Besides, the pathologic nature of mitral regurgitation, the severity of mitral regurgitation, the possibility of successful mitral repair, the development of atrial fibrillation and the presence of pulmonary hypertension, together with the hemodynamic response to exercise. Advances in the understanding of natural pathophysiologic nature of progressive mitral regurgitation and successful technical surgical repair have extended the role of early surgical intervention even in asymptomaticpatients with normal LV function.

Optimal Timing and Evaluation of Liver Transplantation / 대한간학회지

No abstract available.