Postoperative care to patients with pancreaticoduodenectomy combined with vascular allotransplantation / 现代临床护理

Objective To probe into methods for postoperatively nursing the patients undergoing pancreaticoduodenectomy combined with vascular allotransplantation. Method The clinical data of postoperative care to 2 patients with pancreatic head carcinoma treated with pancreaticoduodenectomy combined with vascular allotransplantation at the First Affiliated Hospital of Sun Yat-sen University between August 2014 and October 2014 were retrospectively analyzed. Results The two patients lived through the operation, with the operation time of 480 mins, volume of intraoperative blood loss volume of 3000 mL and 600 mL, no complications, hospital stay of 42 days and 27 days. Conclusions The patients undergoing pancreaticoduodenectomy combined with vascular allotransplantation are susceptible to postoperative complications. The nursing care including close observation of disease conditions , drainage tubes care, nutritional care and prevention of complications are critical for the success of operation.

Clinical significance of monitoring bone turnover markers changes before and after growth hormone treatment of prepubertal children with idiopathic short stature / 中华实用儿科临床杂志

Objective To detect the levels and study the clinical significance of serum procollagen type Ⅰ amino-terminal propeptide (PINP) and β-C-telopeptides of type Ⅰ collagen (β-CTX) as bone turnover markers in recombinant human growth hormone (rhGH) treatment of prepuberty idiopathic short stature (ISS) children.Methods Forty patients of ISS (18 boys and 22 girls) had been collected and treated with GH 0.15 IU/(kg · d) injection every night.Serum levels of PINP,β-CTX,insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP3) were measured by electrochemiluminescence immunoassay in ISS before treatment and after 3,6 months,and they were also measured in 50 healthy children of the healthy control group,and the height,weight,body mass index,height standard difference score (HtSDS),bone age and growth rate were recorded.Results (1) In ISS group,the serum level of PINP[(479.51 ± 134.61) μg/L] was lower than that of the healthy control group [(651.31 ± 212.41) μg/L],the level of β-CTX[(0.84 ± 0.33) μg/L] was higher than that of the healthy control group [(0.50 ± 0.15) μg/L].The differences were statistically significant (t =2.276,-2.709,all P ＜ 0.05).(2) The serum levels of PINP and β-CTX had no significant difference in 18 boys and 22 girls before and after GH treatment (P＞0.05) of ISS.After 3 months of GH treatment,the serum levels of PINP[(736.15 ± 156.59) μg/L] and β-CTX [(1.08 ± 0.27) μg/L] were higher than those before treatment in 40 cases,and the difference was statistically significant (t =4.736,2.497,all P ＜ 0.05),as the increase of PINP was particularly significant.HtSDS (-2.95 ±0.43),compared with before treatment (-2.69 ± 0.58),was significantly different (t =2.714,P ＜ 0.05).However,after 6 months of GH treatment,the levels of PINP[(860.90 ±254.59) μg/L] and β-CTX[(0.94 ±0.32) μg/L] increased slowly (t =1.366,-0.831,all P ＞ 0.05).HtSDS (-2.51 ± 0.54) showed no significant difference (t =1.609,P ＞ 0.05) compared with 3 months of treatment.(3) The serum level of PINP was positively correlated with IGF-1 and IGFBP3 (r =0.636,0.673,all P ＜ 0.05),and there was no correlation with β-CTX (r =0.336,P ＞0.05).PINP and β-CTX had significant correlation with HtSDS (r =0.655,0.782,all P ＜ 0.05).Conclusions The serum PINP and β-CTX as bone turnover markers in serum can be used as one of the early supplementary indicators to predict GH response of ISS.

Perioperative nursing of patients with hepatocellular carcinoma combined with portal vein tumor thrombus after hemi-hepatectomy and removal of portal vein tumor thrombus / 现代临床护理

Objective To investigate the perioperative nursing after hemi-hepatectomy and removal of portal vein tumor thrombus(PVTT)for hepatocellular carcinoma(HCC)with PVTT.Methods Fifty-seven HCC patients with PVTT underwent hemi-hepatectomy and removal of PVTT.Careful perioperative nursing was given to each patient.Results All patients successfully lived through surgery.Postoperative complications included 12 cases pleural effusion(21.1%),2 cases refractory ascites(3.5%)and 1 case perioperative death(1.8%).Conclusion Preoperative psychological care,improvement of nutrition and liver function,prevention of upper gastrointestinal bleeding and postoperative observation plus nursing care were of great importance to ensure the success of the surgery.

Effects of subclinical hypothyroidism on bone age and height in children / 中国综合临床

Objective To investigate the effects of pediatric subclinical hypothyroidism on bone age and height and their treatment outcome.Methods Ninety-seven children with subclinical hypothyroidism were served as this study group and 80 children with normal thyroid function as control group.Bone age and height were detected.Patients in study group were treated with thyroid hormone replacement therapy.The efficacy and lipid changes were evaluated before and after treatment.Results The height and bone age in patients of study group were (1.31 ± 0.06) m and (8.29 ± 0.35) years,significantly lower than the control group ((1.41± 0.09) m,(10.02 ± 1.45) years; t =13.532,P ＜ 0.001 and t =14.590,P ＜ 0.001).Thyroid-stimulating hormone showed a significant negative correlation with bone age (r =-0.783,P ＜ 0.001).In a total of 97 children with subclinical hypothyroidism,71 cases were cured,24 cases with improvement and 2 cases with ineffective,and the total effective rate was 97.9％.Before treatment total cholesterol ((3.45 ±0.42) mmol/L),low density lipoprotein cholesterol((2.50 ± 0.35) mtmol/L) in the study group were significantly higher than those of control group((3.33 ± 0.26) mmol/L,(2.24 ±0.22) mmol/L;t =4.378,5.103 ;P =0.036,0.002).After treatment,the level of low density lipoprotein cholesterol in children with subclinical hypothyroidism was significantly lower than before treatment((2.34 ±0.36) mmol/L vs (2.50 ±0.35) mmol/L,t =4.389,P =0.033),but there was no significant difference in terms of other parameters.Contusion Children with subclinical hypothyroidism can lead to lower bone age and shorter height and it may also lead to changes in lipid levels.More attention should be paid on this disease and early intervention should be provided.

Fast Volume Clipping of Medical Images on GPU / 中国医学物理学杂志

Objective: When the region of interest is somewhere in the middle of the volumetric data, it will be occluded by other regions of the volumetric data and will be hard to see in the reconstruction of volume rendering. In order to provide doctor with comprehensive, visual and accurate diagnostic information, fast volume dipping of medical images on GPU is proposed in the paper. Methods: The rapid volume clipping is achieved by combining the dipping algorithm with the fast volume rendering algorithm based on GPU. The technique is based on fast volume tendering of medical images on GPU. It works as follows: The space information of the section plane is sent to the shader. Then compare the position of the volume data sets with the section plane to decide whether the data is clipped or not. Our algorithm is different from the algorithm that clipping based on depth stencil. We can see the result that reconstructed from the data sets that remained from any position as long as the section plane is defined. Results: According to the shape the users defined, our algorithm can decide which parts of the volume have to be clipped. Because of using the general graphics hardware acecleration, the proposed method achieves interactive display rate. Conclusions: The experiment shows that the algorithm is significantly fast and can meet the requirements of real-time interactive rendering on the premise of ensuring imaging quality and can be used in surgery simulation and so on.

Clinical application of emergency extracorporeal circulation / 医学研究生学报

Objectives: To evaluate the clinical application of emergency extracorporeal circulation(ECC) in cardiac surgery. Methods: Emergency open heart surgery was performed in 24 ECC cases. Warm blood left heart bypass was performed in 3, hypothermic cardiopulmonary bypass in 21. The vena cava-aorta extracorporeal circulation was built in 16,vena cava-femoral in 4, left atrium-femoral in 3 and femoro-femoral in 1. Retrograde or antegrade perfusion through aortic root were applied to protect the heart. Results: There were 2 hospital deaths, the hospital mortality rate was 8.3%. The cardiopulmonary bypass was established in 10 to 15 minutes with an average duration of cardiopulmonary bypass of 78～132 minutes. Twenty-two patients were discharged from the hospital and have resumed a normal and active life style. Conclusions: Emergency cardiopulmonary bypass support is a powerful resuscitative tool that may stabilize the condition of patients with cardiogenic shock and mutiorgan dysfunction to allow for definitive intervention. The femoro-femoral cannulation is the first choice for emergency. The time to establish extracorporeal circulation should be as short as possible.