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Objective:To investigate the therapeutic clinical effect of laparoscopic high uterosacral ligament suspension (LHUS) combined with cervical amputation and vaginal sacrospinal ligament fixation (SSLF) in the treatment of prolapse of uterus in childbearing period.Methods:From October 2011 to December 2016, the clinical data of 78 patients with uterine prolapse above grade Ⅱ treated in Department of Gynecology, Jizhong Energy Fengfeng Group Hospital were retrospectively analyzed.According to different surgical methods, the patients were divided into LHUS group (40 cases) and SSLF group (38 cases). The operation time, intraoperative bleeding volume and hospital stay of the two groups were compared by independent sample t test.Before and 6 months after the operation, the prolapse quality of life questionnaire (P-QOL), pelvic organ prolapse/incontinence sexual function questionnaire-12 (PISQ-12) and pelvic floor distress inventory-short form 20 (PISQ-20) were used.PFDI-20 and pelvic floor impact questionnaire-short 7 (PFIQ-7) were used to evaluate patients′ quality of life, sexual function and pelvic floor function.Paired t test was used to compare the above scores before and 6 months after operation in the same group.Results:There were no significant differences in operation time, intraoperative bleeding volume and hospital stay between the two groups ( t value were 1.593, 1.203 and 0.535, , respectively, all P>0.05). The preoperative P-QOL, PISQ-12, PFDI-20, and PFIQ-7 scores of patients in the LHUS group were (55.4±11.1), (25.1±4.6), (15.0±4.9), (8.9±2.8) points, and (53.7±10.5), (23.9±3.7), (14.1±4.2), (9.2±3.0) in the SSLF group.There was no statistically significant difference in the indexes between the two groups before operation (t value were 0.694, 1.265, 0.869 and 0.457, respectively, all P>0.05). The scores of P-QOL, PISQ-12 at 6 months after operation in LHUS group((87.9±12.0), (39.1±6.1)) and SSLF group((81.3±11.7), (35.6±4.0)) were significantly higher than those before operation( t value were 12.574, 11.589, 10.823 and 13.236, respectively, all P<0.001). The scores of P-QOL and PISQ-12 at 6 months after operation in the two groups were higher than those before operation((87.9±12.0), (39.1±6.1)), and the P-QOL score of LHUS group was higher than that of SSLF group 6 months after operation, the difference was statistically significant ( t value were 12.574, 11.589, 10.823 and 13.236, respectively, all P<0.001). At 6 months after operation, PFDI-20 and PFIQ-7 scores in LHUS group((2.1±0.3), (1.3±0.2) points) were significantly lower than before operation ( t value were=16.619 and, 17.123, all P<0.001). The PFDI-20 and PFIQ-7 scores in LIHUS group were lower than those in SSLF group((2.7±0.3), (1.9±0.2)) at 6 months after operation (t values were 10.096 and 13.073, respectively, all P<0.001). Conclusion:LHUS combined with cervical resection in the treatment of prolapsed uterine prolapse can effectively improve the quality of life, sexual function, and pelvic floor function.The effect is better than SSLF, which is worthy of clinical promotion.
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Objective To analyze the types and risk factors of community-acquired infections (CAI)in diabetic patients by system analysis method of evidence-based medicine.Methods China National Knowledge Infrastructure (CNKI),Wanfang database,VIP database were searched by computer,domestic published researches on CAI and related risk factors in dia-betic patients were aggregated,Meta-analysis was conducted by stata 1 1 .0 software.Results A total of 1 2 literatures were included in the study .The average rate of CAI in diabetic patients was 39.55% (22.12%-55.86%).The major infec-tions were respiratory system infection(40.74%),urinary tract infection(27.35%),tuberculosis(10.80%),skin and soft tissue infection(9.19%),and hepatobiliary system infection (5.57%).Stratified analysis on risk factors revealed that OR and OR95%CI of chronic complication,age,disease course,glycemic control,gender,type of diabetes,subtype of ketoac-idosis was 1.63(1.45,1.82),1.30(1.19,1.42),1.47(1.35,1.61),0.68(0.61,0.76),0.69(0.64,0.75),1.37 (1.13,1.66 )and 0.87(0.62,1.23),respectively.There was no publication bias and combined results were stable. Conclusion The main CAI in diabetic patients are respiratory system infection,urinary tract infection,tuberculo-sis,skin and soft tissue infection,and so on ;several factors,such as female,older age,long-term disease course, poor glycemic control,and complication,can contribute to the increase of CAI in diabetic patients.
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Objective To evaluate the clinical effects of long-term domiciliary oxygen therapy (LDOT)in accompany with pummonary rehabilization program on the patients with chronic obstructive pulmonary disease (COPD).Methods Seventy two COPD cases receiving LDOT treatment were randomized into treatment group and control group.The patients in control group were given LDOT alone,while the treatment group was given pulmonary rehabilization besides LDOT.Lung functions,arterial blood gas parameters and blood rheological parameters were compared between the two groups 2 years after the observation.Results The follow-up period lasted for 1 - 2 years.The frequency of acute exageration in the treatment group ( 3.0 ± 1.3 ) was significantly lower than that of control group (4.0 ± 1.6) ( t =1.893,P ＜ 0.05 ).Compared with that of control group,the FEV1([1.59±0.08]L vs.[1.41 ±0.13]L,t =-3.966,P ＜0.01),FVC ([2.47 ±0.20]L vs.[2.27 ±0.17]L,t=-2.788,P＜0.05),FEV1％ ([2.47±0.20]％ vs.[2.27±0.17]L,t=-4.402,P＜0.01) and PaO2 ( [79.1 ± 8.9 ] kPa vs.[ 60.0 ± 6.6 ] kPa,t =- 4.622,P ＜ 0.01 ) were significantly increased,while plasma viscosity ( [ 2.14 ± 0.31] mPa · s vs.[ 2.44 ± 0.45 ] mPa · s,t =1.985,P ＜ 0.05 ),Low shear blood viscosity ( [ 13.48 ± 1.97 ] mPa · s vs.[ 14.33 ± 1.87 ] mPa · s,t =2.126,P ＜ 0.05 ),median shear whole blood viscosity( [ 6.33 ± 0.66 ] mPa · s vs.(7.92 ± 0.98 ) mPa · s,t =4.238,P ＜ 0.01 ),high shear whole blood viscosity ([4.58 ±0.59] mPa · s vs.[5.33 ±0.68]mPa · s,t =0.3890,P ＜0.01) and erythrocyte sedimentation rate ( [ 30.63 ± 5.76 ] mm/1 h vs.[ 35.63 ± 6.925 ] mm/1 h,t =2.230,P ＜ 0.05 ) was greatly decrease.Conclusion Long-term domiciliary oxygen therapy in company with pulmonary rehabilization program is helpful to improve the lung function,arterial blood gas parameters and rheological status of COPD patients.
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ObjectiveTo evaluate the safety and efficacy of biological meshes (human aceUular dermal matrix mesh) in single-stage repair of infected or contaminated abdominal abdominal wall defects and abdominal hernias. MethodsSeventeen patients with abdominal wall defects or abdominal hernias were enrolled. The wounds of all these patients were infected or contaminated due to the existence of enterocutaneous fistula or stoma, wound infection and synchronous colonic resection. The diagnosis included enterocutaeneous fistula 8 cases, incisional hernia 6 cases, incarcerated inguinal hernia 1 case and cylindrical abdominoperineal resection for rectal cancer for 2 cases. The sizes of abdominal defects ranged from 3 cm × 2 cm to 6 cm × 17 cm, and all the cases were repaired with human acellular dermal matrix mesh(RENOV(R)). Most of the patients were repaired with intraperitoneal onlay mesh technique( IPOM, for 12 cases), and other methods included Lichtenstein operation for 1 case, inlay repair for 2 cases and sublay for 2 cases. Results All the 17 patients recovered uneventfully. For 12 patients, the wounds were sutured at operation and only one case of delayed healing occurred due to fat liquefaction. For the other 5 patients, the wounds were left open and healed after vacuum assisted closure (VAC) therapy or wet- to- dry dressing changes. On follow up for 8.3 ±4.5 months ( 1 to 15 months), no occurrence of incisional hernia or recurrence was found. laxity of abdominal wall occurred in one case. A patient complained intermittent pain of the site of suture for mesh fixing two months after operation and the pain resolved spontaneously one month later. ConclusionsThe biological mesh, acellular dermal matrix mesh, could be used in single- stage repair of infected or contaminated abdominal wall defects safely and effectively, although the long-term outcome still needs further evaluation.
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Objective To survey the prevalence of greenhouse farmer's lung and related risk factors in part of rural areas of Liaoning Province.Methods Using uniform scheme,procedures and questionnaire,a survey for 5420 farmers(2660 men and 2760 women)with complete data who work inside greenhouses was performed in Shenyang,Xinmin,Chaoyang,and Jinzhou between August 2006 and June 2009.Pulmonary function tests was performed for every active farmer.Results Greenhouse farmer's lung was diagnosed in 308 cases,205 men(66.55%,205/308)and 103 women(33.44%,103/308),a prevalence of 5.7%(308/5420).The prevalence rate of greenhouse farmer's lung in males was significantly higher than that in females(?2=39.93,P0.05).In the 308 cases,the number of patiernts presented with fever chill,cough/sputum,chest tightness/shortness of breath were 180(58.44%),192(62.34%),160(51.95%)respectively,and the number of crepitations,radiological changes,spirometry abnormalities and serum IgE antibodies(+)was 164(53.25%),153(49.68%),147(47.73%)and 136(44.16%)at the time of the study.62.34%(192/308)of patients with greenhouse farmer's lung were mild and 38.66%(116/308)were severe.Conclusion The total prevalence rate of greenhouse farmer's lung in part of rural areas of Liaoning Province was 5.7% and multiple risk factors were associated with the disease.