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Objective:To explore the influencing factors of early postoperative complications after radical resection of congenital choledochal cyst (CCC) in a single center and provide some clinical basis and guidance for reducing postoperative complications.Methods:Case control study.Clinical data of 124 children (29 boys and 95 girls) with CCC diagnosed and radically treated at the Affiliated Hospital of Zunyi Medical University from September 2010 to October 2019 were analyzed.According to postoperative complications (bile leakage, gastrointestinal anastomotic fistula, bleeding, incision dehiscence, cholangitis, abdominal infection, pancreatitis, and lymphatic fistula), these children were divided into the complication group (group A) and non-complication group (group B). Age, laboratory indicators[preoperative white blood cell (WBC) count, hemoglobin, glutamic pyruvic transaminase, prealbumin, and postoperative albumin], and clinical factors, such as operation method, operation time, intraoperative blood loss, cyst type, cyst diameter, hepatic duct diameter, abdominal operation history, biliary sludge and calculus, hepatic duct anatomic variation, and pancreaticobiliary maljunction were statistically analyzed between the two groups.The t-test was performed for normal distribution of the measurement data, and the non-parametric rank sum test for non-normal distribution.Multivariate analysis was made using Logistic regression. Results:Among the 124 children, 25(20.16%) had complications, and 99(79.84%) had no complications.Bile leakage occurred in 14 children (11.29%), of whom 7 received operation again and 7 received conservative treatment.Gastrointestinal anastomotic fistula occurred in 2 children (1.61%), of whom 1 was re-operated and 1 was cured conservatively.One child (0.81%) was complicated with bleeding and cured by re-operation.Two children (1.61%) were complicated with incision dehiscence, of whom 1 was cured by re-operation and 1 was cured by conservative treatment.Cholangitis in 2 children (1.61%), abdominal infection in 2 children (1.61%), pancreatitis in 1 child (0.81%), and lymphatic fistula in 1 child (0.81%) were all conservatively cured.No significant difference was found in non-normal distribution indicators-age and WBC count-between the two groups (all P>0.05). Blood loss volume and cyst diameter were significantly different between the two groups (all P<0.05). Postoperative albumin[(27.84±4.62) g/L vs.(32.45±3.72) g/L] meeting the normal distribution showed a statistically significant difference between the two groups ( t=5.254, P<0.05). Logistic multivariate regression analysis suggested that preoperative anemia ( OR=7.922, 95% CI: 1.468-42.757) and biliary sludge and calculus ( OR=1.295, 95% CI: 1.075-4.359) were independent risk factors for postoperative complications; postoperative albumin ( OR=0.055, 95% CI: 0.012-0.244) was a protective factor for postoperative complications, and the differences were statistically significant (all P<0.05). Conclusions:The larger the cyst diameter, the more the intraoperative bleeding, and the higher the risk of operation.Treating anemia before operation, clearing sludge in the hepatic duct during operation, reducing bleeding, and strengthening the monitoring of albumin and hemoglobin during the perioperative period can prevent and reduce early complications after radical resection of CCC in children.
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Constructing a doctor-patient community with a shared future requires efforts from both the medical supply side and the patient demand side, with special attention to the needs of patients. Continuously meeting and improving the needs of patients is the starting point, ultimate goal, and evaluation standard for constructing a doctor-patient community with a shared future. Therefore, this paper proposed the proposition of "what patients need", that is, what needs do patients have and how to meet their needs. The fundamental needs of patients are to diagnose and treat diseases and recover from illness, which are specifically manifested in the demands to narrate the disease’s feelings, the willingness to participate in medical decision-making, the experience of diagnosis and treatment in the process of medical treatment, and the satisfaction evaluation of the hospital’s performance appraisal. On the basis of clarifying the needs of patients, this paper proposed the paths and methods to meet patients’ needs, and provided new ideas for constructing a doctor-patient community with a shared future.
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Objective:To synthesize the findings of qualitative research on the treatment experience of cancer patients receiving immune checkpoint inhibitors therapy to provide a basis for developing relevant health education strategies and other supportive care interventions.Methods:Qualitative research on the treatment experience of cancer patients receiving immune checkpoint inhibitors therapy, published by May 2022, were searched in English and Chinese databases, including Cochrane Library, PubMed, Embase, PsycINFO, CINAHL, Web of Science, CNKI, Wanfang, VIP, and CBM. The quality of the included studies was evaluated by Joanna Briggs Institute Critical Appraisal Tool for qualitative studies. The research results were summarized and Meta-synthesis using the pooled integration method.Results:A total of 13 articles were included and 62 findings were grouped into 12 new categories according to their similarities. These 12 categories resulted in 4 synthesized findings: life was affected, facing multiple decision scenarios, presence of some unmet needs and gaining positive experiences and personal growth.Conclusions:Although patients experience some positive experiences, a large proportion of them experience significant health distress. Healthcare professionals should develop targeted health education with supportive care strategies on the basis of a comprehensive assessment.
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Since the cluster of the 2019 novel coronavirus (2019-nCoV) pneumonia, a large number of patients gathered, the mortality of critical patients has remained high and the treatment was unclear. In this outbreak, Hunan Changde region immediately set up a hospital and intensive care unit. The patients relieved through respiratory support, hemodynamics management, nutritional support, the application of antiviral drugs, analgesic and sedation. The treatment experience in severe cases of 2019-nCov pneumonia patients were summarized as follows: in terms of respiratory support, we needed to pay attention to the advantages of high-flow nasal cannula oxygen therapy (HFNC) and the intervention of mechanical ventilation, pay attention to the ventilator parameters, and adopt prone position timely. In the aspects of fluid resuscitation and volume management, we should pay attention to the characteristics of severe patients' volume status, perform early evaluation, and clinicians should focused on hemodynamic management beside the bed. In the aspect of nutritional support and evaluation and maintenance of intestinal function, early enteral nutrition should be adopted in time. However, the trade-off between the risk of intestinal function and nutritional support in patients with mechanical ventilation and the antiviral benefits of Kaletra needed to be reevaluated, the optimized way of analgesia and sedation was adopted, at the same time, the usage and side effects of antiviral drugs should be paid attention to. We should grasp the opportunity of transportation for severe patients. It is suggested that some warning scores should be used to facilitate early recognition of patients with severe infection and then they should be earlier transferred to the designated hospital for intensive care.
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Tibial transverse transport (TTT) was firstly applied to treat thromboangiitis obliterans successfully by Professor QU Long in China in 2000. Based on this, the team of Professor HUA Qikai in the First Affiliated Hospital of Guangxi Medical University applied this technique to treat diabetic foot since 2013, and until now, more than 500 patients underwent this treatment with excellent effectiveness including a salvage rate as high as 96.1%. Our team also improved this technique in many aspects, and developed a TTT-based classification system and treatment for diabetic foot. We also explored the underlying mechanism of TTT treatment using imaging, histology, and other basic research methods. To further promote the application of this technique in clinic, we reported the findings from our cases and reviewed our previous findings in this study.
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Objective@#To summarize the measures and experience of treatment in mass extremely severe burn patients.@*Methods@#The clinical data and treatment of 8 extremely severe burn patients in August 2 Kunshan factory aluminum dust explosion accident who were admitted in the 100th Hospital of PLA on August 2nd, 2014, were retrospectively analyzed. There were 4 males and 4 females, aging 22-45 (34±7) years, with total burn area of 55%-98% [(89±15)%] total body surface area (TBSA) and full-thickness burn area of 45%-97% [(80±21)%] TBSA. All the 8 patients were accompanied with severe shock, inhalation injury, and blast injury. According to the requirements of former PLA General Logistics Department and Nanjing Military Command, a treatment team was set up including a special medical unit and a special care unit, with Chai Jiake from the First Affiliated Hospital of PLA General Hospital as the team leader, Zheng Qingyi from the 175th Hospital of PLA (the Affiliated Dongnan Hospital of Xiamen University) as the deputy leader, the 100th Hospital of PLA as the treatment base, and burn care, respiratory, nephrology, nursing specialists from the First Affiliated Hospital of PLA General Hospital, and the burn care experts and nursing staff from the 180th Hospital of PLA, 118th Hospital of PLA, 98th Hospital of PLA, and 175th Hospital of PLA, and nurses from the 85th Hospital of PLA, 455th Hospital of PLA, 101th Hospital of PLA, 113th Hospital of PLA as team members. Treatment strategies were adopted as unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns. With exception of one patient who received deep vein catheterization before admission, the other 7 patients were treated with deep vein catheterization 0.5 to 3.0 hours after admission to correct hypovolemic shock as soon as possible. Eight patients received tracheotomy, and 7 patients were treated with mechanical ventilation by ventilator in protective ventilation strategy with low tide volume and low volume pressure to assist breathing. Fiberoptic bronchoscopy was done one to three times for all the 8 patients to confirm airway injuries and healing status. Escharectomy and Meek dermatoplasty in the extremities of all the 8 patients were performed 3 to 6 days after injury for the first time. Escharectomy, microskin grafting, and covering of large pieces of allogeneic skin on the trunks of 4 patients were performed 11 to 16 days after injury for the second time. The broad-spectrum antibiotics were uniformly used at first time of anti-infective therapy, and then the antibiotics species were adjusted in time. The balance of internal environment was maintained and the visceral functions were protected. One special care unit was on responsibility of only one patient. Psychological intervention was performed on admission. The rehabilitative treatment was started at early stage and in company with the whole treatment.@*Results@#Acute renal injury occurred in 5 patients within 36 hours after injury and their renal function was restored to normal 4 days after injury due to active adjustment of fluid resuscitation program. No pulmonary complications, such as severe pulmonary infection and ventilator-associated pneumonia, occurred in the survived patients. One of the 8 patients died, and the other 7 patients were cured successfully. The wounds were basically healed in 2 patients in 26 or 27 days by 2 or 3 times of operation, and in 5 patients by 4 or 5 times of operation. The basic wound healing time was 26-64 (48±15) days for all the 7 patients.@*Conclusions@#Treatment strategies of unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns are the bases to successful treatment. Correcting shock as soon as possible is the prerequisite and closing wound as soon as possible is the key to successful treatment. Comprehensive treatment measures, such as maintaining and regulating the function of viscera, improving the body immunity, and preventing and treating the complications, are the important components to successful treatment. It is emphasized that in the treatment of mass extremely severe burn patients, specialist burn treatment should always be in the dominant position, and other related disciplines may play a part in auxiliary function.
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[Purpose] To summarize SHEN Yiping's clinical experience and academic views about treatment of elderly acute myeloid leukemia(AML) patients with traditional Chinese medicine(TCM).[Method] By means of learning form Professor SHEN in the clinic,collect cases and analyze them,and then conclude his clinical thought and dialectical methods,further summarize his clinical experience and academic views.[Result] Professor SHEN Yiping believes that these patients have deficiency of the lung,spleen and kidney,easily form the unhealthy environmental influences with shapes such as phlegm,damoeness,blood stasis,meeting with invaded by the invasion,causing the results of the happening of the disease.The functions of Zang-fu are damaged after chemotherapy,with the presentation of deficiency of qi and yin.Professor SHEN thinks that the treatment should be tonifying lung,spleen and kidney,dispelling the pathological products such as phlegm,dampness,blood stasis,eliminating the invasion at the same time.For those patients who are in remission,we should use the therapy of purging fire and maintaining yin,in order to remove leukemia residual of lesions thoroughly.Professor SHEN uses the anticancer drugs which could clear away heat and toxic frequently in order to depress the proliferation of the leukemia cells.[Conclusion]Professor SHEN is well-versed in the learning of both TCM and modern medicine,abundant clinical experience and rigorous dialectical methods,skilled in using TCM to treat elderly AML patients.He also has peculiar methods for the treatment of patients with recurrence of leukemia.His clinical experience and academic thoughts are worth learning and communication for us.
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Objective To explore the pregnancy outcomes and clinical treatment principles of pregnancy with oligohy-dramnios. Methods Clinical data of 72 cases of pregnant women with oligohydramnios were analyzed retrospectively from January 2010 to January 2012 in our hospital, and at the same time selected 72 cases normal amniotic fluid preg-nant women as the normal amniotic fluid group. Pregnancy complications, confining conditions begat outcome and mode of delivery were compared between two groups. Results The rate of prolonged pregnancy, gestational hypertension, postpartum hemorrhage, intrauterine growth retardation, oligohydramnios group meconium-stained amniotic fluid, fetal distress, fetal malformations and neonatal asphyxia amniotic fluid in were significantly higher than the normal group (P<0.05), cesarean section rate of oligohydramnios group was 58.33%, incidence of vaginal delivery was 15.28%, cesarean section rate of normal amniotic group was 27.78%and the incidence of vaginal delivery was 8.33%, there were significant differences (P<0.05). Conclusion The treatment method of oligohydramnios pregnant women in different peri-ods is different, non full term pregnancy oligohydramnios patients treated with increasing amniotic fluid, full-term preg-nancy oligohydramnios patients should given termination of pregnancy timely.
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Objective This paper sums up professor Zhang Peiying's clinical experience in diagnosing and treating unstable angina(UA) of coronary heart disease. [Methods]Generalizing the pathogenesis, rules of treatment and principle of diagnosis about UA, through the reference of classical theory of Traditional Chinese medicine and clinical observation. Then analyse professor Zhang Peiying's characteristics about diagnosing and treating UA by two examples of medical record.[Results]Professor Zhang considers deficiency of Qi and stagnation of phlegm is the premise and foundation of UA, holds that stagnation of phlegm, stagnation of blood and spasm of heart vessel are the key causes of the disease and removing blood stasis, relieving spasm of vessel, strengthening the spleen and reducing phlegm is the basic treatment principle. He divides UA into 4 categories: stagnation of heart blood syndrome, stagnation of phlegm and blood syndrome, deficiency of Qi and stagnation of blood syndrome,weakness of Yang with stagnation of phlegm and blood. [Conclusions]Professor Zhang Peiying's scholar thought and clinical experience in diagnosing and treating UA of coronary heart disease is effective. His thought and clinical experience are worth extending and applying.
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Objective To study the results using T-tube and retroperitoneal space drainage to manage perforating injury of the distal common bile duct(PIDC) during common bile duct(CBD) exploration.Methods We retrospectively analyzed the clinical data of 12 patients who were diagnosed to suffer from PIDC during CBD exploration from 2010 to 2012.Result All these 12 patients who received T-tube and retroperitoneal space drainage,gastrointestinal decompression,nutritional support and antibiotics recovered uneventfully.Conclusion Given that the CBD was unobstructed,T-tube and retroperitoneal space drainage was an good treatment for patients with PIDC.
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[Objective] To sum up the clinical experience of treating nasopharyngeal carcinoma with TCM syndrome differentiation by professor Piao Bingkui. [Method] By analyzing the idea of Piao's therapy and medication of the proven case, it elaborates Pro. Piao Bingkui's clinical experience on using Chinese herbs, supporting the health and strengthening the root, anti-cancer and detoxification, to treat nasopharyngeal carcinoma. [Results] Pro. Piao Bingkui adepted at long-term maintenance therapy of TCM, which relieved the patient's clinical symptoms, and improved the quality of life significantly, and achieved satisfactory clinical outcome, according to the patient's previous treatment, the condition changes. [Conclusion] Pro. Piao Bingkui treated nasopharyngeal carcinoma depending on the different courses of individual, who used the methods of supporting the health and strengthening the root, anti-cancer and detoxification, could reduce the radiotherapy and chemotherapy toxicity, improve the body's resistance to disease and reduce the recurrence rate. It has important clinical significance.
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Objective To explore the clinical data of the pediatric malignant solid tumor and to summarize the experiences of the pediatric malignant solid tumor treatment in Guangxi.Methods The clinical data of 323 cases of pediatric malinant solid tumor,treated surgically in the First Affiliated Hospital of Guangxi Medical University from Dec.1988 to Dec.2008.Pathology,sex,age,clinical characteristics,diagnosis and treatment were analysed respectively.Results The most frequent histological types were malignant lymphoma,Wilms tumor,neuroblastoma and malignant germ cell tumor.There was a male prevalence with a sex-ratio of 1.99 ∶ 1.The peak incidence in embryo tumor was under 3 years,and epithelium cancer was between the ages of 10-13 years.The main symptoms were palpable mass (56.3) and a few were found in health examination ;64.2％ of the pediatric malignant solid tumor was of stage Ⅲ or Ⅳ ;the complete tumor resection rate was 78.4％.Conclusions The characteristics of pediatric malignant solid tumor is different from those of adults.To detect as soon as possible and treat the pediatric malignant tumor as soon as possible depends on screening.Combined modality therapy can improve the patients complete resection rate and survival quality of the patients.