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A 63-year-old maintenance hemodialysis patient with diabetic nephropathy was reported. The patient was incapacitated, with systemic edema, heart failure, severe anemia, malnutrition, gastrointestinal bleeding, and intractable hypertension. We adopted integrated management methods such as "multidisciplinary collaboration" and "doctor-patient collaboration": by accurately controlling the volume load to protect the residual renal function, taking into account the treatment of underlying diseases and complications, integrating the clinical parameters of dialysis and the interdialysis period, and combining the subjective clinical symptom score with the objective index analysis, the objectives of effectively controlling the dry weight of patients, alleviating complications, improving nutrition and protecting the residual renal function were finally achieved. The quality of life of the patient had been significantly improved.
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Objective To investigate the risk factors of pneumonia in maintenance hemodialysis (MHD) patients. Methods The clinical data of patients undergoing dialysis longer than three months at the Hemodialysis Center of West China Hospital of Sichuan University from July 2013 to July 2018 were retrospectively analyzed. The patients were divided into pneumonia group and non-pneumonia group. Follow-up time started from admission to the beginning of hemodialysis. All patients were followed until the patient died, or withdrawn from hemodialysis, or transferred to another center, oruntil the study deadline (April 2019). Baseline clinical data were compared between the two groups, and the differences in clinical data between the pneumonia group and the baseline were also analyzed. Risk factors for pneumonia in hemodialysis patients was analyzed by binary logistic regression. Kaplan-Meier curve was used to compare the survival prognosis of the two groups, and the Log-rank method was used for significant test. A multivariate Cox proportional hazard model was used to analyze risk factors for MHD patients' death. Results (1) A total of 311 patients were enrolled in the study, in which 178 (57.2％) of the patients were male, and 75(24.1％) of the patients had pneumonia. Compared with non-pneumonia group, the pneumonia group patients were older (P=0.002), had higher level of white blood cells (P=0.001) and lower level of serum creatinine (P=0.003), albumin (P=0.001), and serum magnesium (P=0.039). There were also statistically significant differences between the two groups in the proportion of females and underlying diseases (all P<0.05). (2) The time of pneumonia occurred from the initial time of dialysis was (10.69 ± 9.82) months. Compared with baseline values, decreased hemoglobin and albumin level were found (both P<0.01). (3) Logistic regression analysis showed male patients had lower risk of pneumonia than female patients (OR=0.438, 95％ CI 0.242-0.795, P=0.007). For every 1 g/L increase in albumin, the risk of pneumonia was reduced by 6.4％ (OR=0.936, 95％CI 0.885-0.991, P=0.022). Kaplan-Meier survival curve analysis showed that the difference in 5-year cumulative survival rate between pneumonia group and non-pneumonia group was statistically significant ( 60.6％ vs 84.4％, χ2=16.647, P<0.001). (4) Multivariate Cox regression analysis showed that long dialysis time (HR=0.870, 95％CI 0.832-0.909, P<0.001) and high serum albumin level (HR=0.898, 95％CI 0.845-0.955, P=0.001) were protective factors in patients with MHD. Pneumonia (HR=3.008, 95％CI 1.423-6.359, P=0.004) was an independent risk factor for death in MHD patients. Conclusions Hemoglobin and albumin level are reduced in MHD patients with pneumonia. Low albumin level is a risk factor for pneumonia in patients. MHD patients with pneumonia have a lower survival time than those without pneumonia.
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Objective To explore the safety and effectiveness of 3D reconstruction in thoracoscopic posterior basal segmentectomy (S10).Methods Between March 2018 to September 2018,14 patients underwent thoracoscopic anatomical resection of the posterior basal segment of the lung (S10).Results Of the 14 patients,including 5 males and 9 females,age (52.2 ± 5.3) years,size (1.1 ± 0.6) cm,6 left S10 and 8 right S10.The number of pathological type of microinvasive adenocarcinoma,benign nodule,and metastatic carcinoma was 12,1,and 1 cases.The average preoperative planning time was (44.9 ± 5.7) min,and the average operation time was (134.8 ±26.3)min.The blood loss was (25.5 ±4.1)ml,with (8.1 ± 2.7) lymphadenectomy,no positive metastasis.The coincidence rate of 3D reconstruction and intraoperative anastomosis in the tumor location,B10,A10,and V10 were 100％ (14/14),100％ (14/14),93％ (13/14) and 71％ (10/14).The median duration of chest tube insertion was (2.3 ±2.1)day.The incidence of postoperative complications was 21％ (3/14),including 7％ (1/14) of air leakage,7％ (1/14) of arrhythmia,14％ (2/14) of pulmonary infection,and 14％ (2/14) of operation.All the cutting edge was ＞ 2 cm.There was no perioperative death,no conversion to thoracotomy or lobectomy.The mean follow-up time was (8.1 ±2.2)months.There were no recurrence,metastasis or death in the 14 patients.One patient had chronic cough and no hemoptysis.Conclusions Preoperative 3D reconstruction make the anatomic thoracoscopic posterior basal segmentectomy (S10) safer and more effective.
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Objective@#To explore the safety and effectiveness of 3D reconstruction in thoracoscopic posterior basal segmentectomy (S10).@*Methods@#Between March 2018 to September 2018, 14 patients underwent thoracoscopic anatomical resection of the posterior basal segment of the lung (S10).@*Results@#Of the 14 patients, including 5 males and 9 females, age (52.2±5.3)years, size (1.1±0.6)cm, 6 left S10 and 8 right S10. The number of pathological type of microinvasive adenocarcinoma, benign nodule, and metastatic carcinoma was 12, 1, and 1 cases. The average preoperative planning time was (44.9±5.7)min, and the average operation time was (134.8±26.3)min. The blood loss was (25.5±4.1)ml, with (8.1±2.7) lymphadenectomy, no positive metastasis. The coincidence rate of 3D reconstruction and intraoperative anastomosis in the tumor location, B10, A10, and V10 were 100%(14/14), 100%(14/14), 93%(13/14) and 71%(10/14). The median duration of chest tube insertion was (2.3±2.1)day. The incidence of postoperative complications was 21%(3/14), including 7%(1/14) of air leakage, 7%(1/14) of arrhythmia, 14%(2/14) of pulmonary infection, and 14%(2/14) of operation. All the cutting edge was >2 cm. There was no perioperative death, no conversion to thoracotomy or lobectomy. The mean follow-up time was (8.1±2.2)months. There were no recurrence, metastasis or death in the 14 patients. One patient had chronic cough and no hemoptysis.@*Conclusions@#Preoperative 3D reconstruction make the anatomic thoracoscopic posterior basal segmentectomy (S10) safer and more effective.
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Objective@#To investigate the risk factors of pneumonia in maintenance hemodialysis (MHD) patients.@*Methods@#The clinical data of patients undergoing dialysis longer than three months at the Hemodialysis Center of West China Hospital of Sichuan University from July 2013 to July 2018 were retrospectively analyzed. The patients were divided into pneumonia group and non-pneumonia group. Follow-up time started from admission to the beginning of hemodialysis. All patients were followed until the patient died, or withdrawn from hemodialysis, or transferred to another center, or until the study deadline (April 2019). Baseline clinical data were compared between the two groups, and the differences in clinical data between the pneumonia group and the baseline were also analyzed. Risk factors for pneumonia in hemodialysis patients was analyzed by binary logistic regression. Kaplan-Meier curve was used to compare the survival prognosis of the two groups, and the Log-rank method was used for significant test. A multivariate Cox proportional hazard model was used to analyze risk factors for MHD patients' death.@*Results@#(1) A total of 311 patients were enrolled in the study, in which 178 (57.2%) of the patients were male, and 75(24.1%) of the patients had pneumonia. Compared with non-pneumonia group, the pneumonia group patients were older (P=0.002), had higher level of white blood cells (P=0.001) and lower level of serum creatinine (P=0.003), albumin (P=0.001), and serum magnesium (P=0.039). There were also statistically significant differences between the two groups in the proportion of females and underlying diseases (all P<0.05). (2) The time of pneumonia occurred from the initial time of dialysis was (10.69±9.82) months. Compared with baseline values, decreased hemoglobin and albumin level were found (both P<0.01). (3) Logistic regression analysis showed male patients had lower risk of pneumonia than female patients (OR=0.438, 95% CI 0.242-0.795, P=0.007). For every 1 g/L increase in albumin, the risk of pneumonia was reduced by 6.4% (OR=0.936, 95% CI 0.885-0.991, P=0.022). Kaplan-Meier survival curve analysis showed that the difference in 5-year cumulative survival rate between pneumonia group and non-pneumonia group was statistically significant (60.6% vs 84.4%, χ2=16.647, P<0.001). (4) Multivariate Cox regression analysis showed that long dialysis time (HR=0.870, 95% CI 0.832-0.909, P<0.001) and high serum albumin level (HR=0.898, 95%CI 0.845-0.955, P=0.001) were protective factors in patients with MHD. Pneumonia (HR=3.008, 95% CI 1.423-6.359, P=0.004) was an independent risk factor for death in MHD patients.@*Conclusions@#Hemoglobin and albumin level are reduced in MHD patients with pneumonia. Low albumin level is a risk factor for pneumonia in patients. MHD patients with pneumonia have a lower survival time than those without pneumonia.
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Objective To observe the effect of platelet-rich plasma(PRP)gel on tendon-bone healing following tendon allograft reconstruction of anterior cruciate ligament(ACL).Methods Bilateral ACL reconstructions using Achilles tendon allografts were performed in 24 New Zealand white rabbits matured skeletally.One knee joint was pretreated with the allograft PRP gel(served as experimental group),while the contralateral knee joint was free from treatment with PRP(served as control group).The reconstructions were assessed histologically,immunohistochemically and biomechanically at 2,6 and 12 weeks.Results At 2 and 6 weeks,Burak scores of experimental group were higher than control group.At 12 weeks,the grafts showed a mature zone of fibrocartilage in experimental group but mature scar tissues on the tendon-bone surface.Immunohistochemistry demonstrated early higher expression of VEGF in experimental group than control group and continually higher expression of TGF-β1 in experimental than control group.In contrast,the grafts of the controls group revealed the development of mature scar tissue resembling Sharpey fibers spanning the tendon-bone interface.At 2 and 6 weeks,the biomechanical analysis revealed the limit load of(15.3±2.9)N and(33.2±6.9)N respectively in experimental group,which were significantly higher than(7.9±1.4)N and(23.7±4.9)N in control group (P ＜ 0.05).Conclusion Application of PRP is the potential means to enhance the earlier healing of the allograft tendon-bone.
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@#Objective To report the clinical effects of microsurgery in treatment of infected extremities after blood vessel prosthesis were transplanted.Methods From Jan.1998 to Dec.2008,8 cases of major vascular injuries in extremities were blood-supplied by cross bridge vascular anastomosis from uninjured extremities,including 4 cases of femoral artery and vein,2 cases of popliteal artery and vein,and 2 cases of brachial artery and vein. Results After 3 years of follow-up,blood circulation of infected extremities were reestablished in each of 8 cases,as well as function and appearance recovered.Conclusion The procedure of cross bridge vascular anastomosis from uninjured extremities may efficiently restitute the blood supply of the infected extremities after blood vessel prosthesis were transplanted,and decrease the rate of amputation.
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Objective To observe angiogenic effect of platelet-released growth factors (PRGF) from platelet-rich plasma (PRP) on mierovessel formation at early stage after anterior crueiate ligament (ACL) reconstruction by freeze-dried Achilles tendon. Methods The study involved 14 rabbits, of which 12 rabbits were used as experiment group and the other 2 as control group. In the experiment group, after two sides of rabbit ACL were removed, freeze-dried Achilles tendon treated by PRGF was transplanted into random one side of the knee to substitute the original ACL (PRGF group), while the other side was transplanted with freeze-dried Achilles tendon treated only by normal saline (NS group). Only one side of the knee was removed in the control group. The grafts were observed by HE and immuno- histeehemical staining 2, 4 and 6 weeks after operation. Microvessel density (MVD) was measured by Weidner method. Results Compared with NS group, MVD in PRGF group was significant higher at 2,4 and 6 weeks after operation (P<0.05). MVD of NS group at 2,4 and 6 weeks after operation was 2.52±0.45, 3.41±0.44 and 2.57±0.51 respectively, but that of PRGF group at 2,4 and 6 weeks af- ter operation was 3.56±0.81,4.91±0.46 and 3.01±0.75 respectively (P<0.05). The time of neo- vascular formation and the depth of vascular penetration into the grafts of the PRGF group were superior to those of NS group. Conclusion PRGF can significantly promote microvessel formation at early stage after ACL reconstruction with freeze-dried Achilles tendon.