Objective To investigate the effectiveness of noninvasive positive pressure ventilation( NPPV) in acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) complicated with severe type Ⅱ respiratory failure.Methods 37 patients who were admitted fromJanuary 2008 to June 2009 due to AECOPD complicated with severe type Ⅱ respiratory failure and had received NPPV therapy were enrolled as a NPPV group. Another similar 42 cases who had not received NPPV therapy served as control. All subjects received standard medication therapy according to the guideline. Arterial blood gases before and after treatment, the duration of hospitalization and intubation rate were observed. Results The arterial pH, PaO2 ,and PaCO2 improved significantly after treatment as compared with baseline in both groups ( P lt; 0. 05) .Compared with the control group, the average duration of hospitalization was significantly shorter ( 10 ±5 vs.19 ±4 days, P lt;0. 05) and the intubation rate was significantly lower ( 2. 7% vs. 16. 7% , P lt;0. 05) in the NPPV group. Conclusion The use of NPPV in AECOPD patients complicated with severe type Ⅱ respiratory failure is effective in improving arterial blood gases, reducing the duration of hospitalization and intubation rate.
Objective To investigate the expression and localization of activating transcription factor 3 ( ATF3) and ATF4 in lung of rats with chronic obstructive pulmonary disease ( COPD) , and explore their possible roles in the pathogenesis of COPD. Methods Twenty-two SD rats were randomly divided into a COPD group and a control group. The COPD model was established by cigarette smoking and intratracheal instillation of lipopolysaccharide. The lung function was measured and the pathological changes were observed under light microscope. In situ hybridization, reverse transcription-polymerase chain reaction ( RTPCR), immunohistochemistry, and Western blot techniques were used to detect the mRNA and protein expressions of ATF3 and ATF4 in rat lung. Results The lung function of the COPD group was significantlydecreased. The rats in the COPD group shared specific pathological features of COPD. Immunohistochemical and Western blot results showed that the protein expressions of ATF3 and ATF4 were higher in the COPD group than those in the control group ( P lt;0. 05) . In situ hybridization and RT-PCR results showed that themRNA expressions of ATF3 and ATF4 in the COPD group were also significantly higher than those in the control group ( P lt;0. 05) . Conclusions The expressions of ATF3 and ATF4 are significantly up-regulated in COPD. These findings suggest that ATF3 and ATF4 may play important roles in the oxidative and antioxidative imbalance in the pathogenesis of COPD.
目的 探讨“医护一体化”疼痛管理模式在骶骨肿瘤患者围手术期的应用效果。 方法 以2011年1月－10月选取的23例骶骨肿瘤患者作为研究对象，根据科室疼痛管理的规范化流程，在“医护一体化”工作模式下由护士进行疼痛评估、医生护士共同制定疼痛管理方案，护士落实个体化疼痛护理措施、规范用药指导、综合心理护理和镇痛效果反馈等。 结果 经“医护一体化”疼痛管理，患者疼痛情况大为改观，20例患者疼痛评分＜3分，占总例数的87.0%，由入院初期的中、重度疼痛患者居多转变为轻度疼痛患者占主导。 结论 运用医护一体化多模式疼痛管理可以有效减轻患者疼痛，提高护理服务质量。
目的:观察在青少年脊柱侧凸患者中术前实施综合性呼吸操锻炼的临床效果方法:选取46例伴有不同程度肺功能障碍的青少年脊柱侧弯患者作为研究对象,对其自入院后第一天即开始实施综合性呼吸操锻炼,观察术前肺功能的变化情况及术后肺部并发症的发生情况。结果:锻炼后患者肺活量(VC)、肺容量(TLC)、用力肺活量(FVC)、最大通气量(MVV),等肺功能指标较锻炼前有明显改善,差异具有统计学意义(Plt;0.05);术后血氧饱和度gt;95%;无肺部并发症发生。结论:入院后即进行综合性呼吸操锻炼能在近期有效改善患者肺功能,提高患者对脊柱矫形手术的耐受力,对预防和减少术后肺部感染以及呼吸功能不全的发生有积极作用。
ObjectiveTo summarize the current status of research in nutritional support for glutamine after hepatectomy.MethodThe literatures on nutritional support of glutamine after hepatectomy in recent years were reviewed by searching domestic and foreign literatures.ResultsThe administration of glutamine up-regulated the expression of liver regeneration genes after partial hepatectomy in malnourished rats, and then stimulated cell mitosis by paracrine and endocrine cells, affecting the uptake of amino acids by hepatocytes and intestinal cells, and promoting hepatocyte proliferation. In clinical applications, glutamine could improve postoperative liver function and immune function, reduce the incidence of infectious complications, then relatively shorten the length of hospital stay, and improve the clinical outcome of patients.ConclusionGlutamine is beneficial to the recovery of liver function and has clinical application value.
ObjectiveTo systematically evaluate the effect of different enteral nutrition timing on patients with pancreaticoduodenectomy.MethodsPubMed, Embase, The Cochrane Library, Web of Science, CBM, CNKI, WanFang Data, and VIP databases were searched to collect RCTs for nutritional support in pancreaticoduodenectomy patients. The search time was established until March 1 2019. After two independent investigators conducted literature screening, data extraction, and evaluation of the risk of bias in the included studies, a meta-metabolic analysis was performed using the R 3.5.3 software gemtc package, JAGS 3.4.0, and Revman software.ResultsA total of 8 RCTs were included, for a total of 825 patients. The results of reticular meta-analysis showed that there was no significant difference in the duration of hospitalization for patients with pancreaticoduodenectomy, between the enteral nutrition supported at different timing. The results of the ranking probability map suggested that preoperative enteral nutrition was a better option for supporting nutrition in patients with pancreaticoduodenectomy, secondly, timing to give was 24–48 hours after operation.ConclusionsAccording to the results of mesh meta-analysis and probabilistic ranking, the nutritional status of patients is corrected before surgery, and the effect of enteral nutrition is better than other nutritional support methods. Secondly, enteral nutrition should be given at 24–48 hours after operation in combination with ESPEN and ERAS recommendations.
ObjectiveTo summarize the effectiveness and experience of Wanger grade 3-5 diabetic foot treated with vacuum sealing drainage (VSD) combined with transverse tibial bone transport.MethodsBetween March 2015 and January 2018, 21 patients with refractory diabetic foot who failed conservative treatment were treated with VSD combined with transverse tibial bone transport. There were 15 males and 6 females, aged 55-88 years (mean, 65 years). The diabetes history was 8-15 years (mean, 12.2 years). The duration of diabetic foot ranged from 7 to 84 days (mean, 35.3 days). The size of diabetic foot ulcer before operation ranged from 2 cm×2 cm to 8 cm×5 cm. According to Wanger classification, 8 cases were rated as grade 3, 11 cases as grade 4, and 2 cases as grade 5. Among the 21 cases, angiography of lower extremity before operation was performed in 5 cases, CT angiography of lower extremity in 16 cases, all of which indicated that the arteries below the knee were narrowed to varying degrees and not completely blocked. Preoperative foot skin temperature was (29.28±0.77)℃, C-reactive protein was (38.03±31.23) mg/L, leukocyte count was (9.44±2.21)×109/L, and the visual analogue scale (VAS) score was 6.8±1.5, and ability of daily living (Barthel index) was 54.3±10.3.ResultsAfter operation, 2 patients with Wanger grade 4 and smoking history failed treatment and had an major amputation (amputation above ankle joint) at 30 days and 45 days after operation, respectively. One patient with Wanger grade 5 and chronic heart failure died of cardiac arrest at 60 days after operation. The remaining 18 patients were followed up 6-24 months (mean, 9.2 months). The external fixator was removed at 40-62 days after operation, with an average of 46 days. All the wounds healed, with a healing time of 50-120 days (mean, 62.5 days). The pain of 18 patients’ feet was relieved obviously, and there was no recurrence of ulcer in situ or other parts. There was no complication such as tibial fracture and ischemic necrosis of lower leg skin after operation. After ulcer healing, the foot skin temperature was (30.86±0.80)℃, C-reactive protein was (22.90±18.42) mg/L, VAS score was 2.4±1.2, and Barthel index was 77.3±4.6, all showing significant differences when compared with preoperative ones (P<0.05); the leukocyte count was (8.91±1.72)×109/L, showing no significant difference (t=1.090, P=0.291).ConclusionVSD combined with transverse tibial bone transport can effectively promote the healing of Wanger grade 3-5 diabetic foot wounds, but smokers, unstable blood glucose control, and chronic heart failure patients have the risk of failure.
目的 探讨血管内皮生长因子（VEGF）及受体Flt-1蛋白表达与卵巢恶性肿瘤临床病理和预后的关系。 方法 2000年1月-2004年6月，以SABC免疫组织化学方法检测48例卵巢恶性肿瘤组织中VEGF及其受体Flt-1蛋白的表达。 结果 VEGF和Flt-1蛋白表达与卵巢恶性肿瘤的病理学类型、分化级别及临床分期无明显相关性（P＞0.05）。有淋巴结转移者VEGF和Flt-1蛋白的表达阳性率均明显高于无淋巴结转移者（P＜0.05）。 VEGF 和Flt-1共同表达者平均总生存期为27.88个月，明显短于没有共同表达者的36.04个月（95%CI 为33.42～38.65，P=0.022 3）。 结论 VEGF和Flt-1蛋白表达与卵巢恶性肿瘤的淋巴结转移相关，可作为预测肿瘤转移及预后的指标。
ObjectiveTo analyze the current status and risk factors of postoperative complications in patients with retroperitoneal tumor (RPT) and to establish a nomogram for predicting the occurrence of postoperative complications. MethodsThe clinicopathologic data of patients with RPT who met the inclusion criteria in the West China Hospital of Sichuan University from June 2019 to May 2022 were retrospectively collected. The risk factors of postoperative complications were analyzed by using univariate and multivariate analyses, and the nomogram was constructed based on the risk factors and validated. ResultsA total of 205 patients were collected in this study, 70 (34.1%) of whom had postoperative complications. The multivariate analysis results of logistic regression showed that the preoperative serum albumin ＜35 g/L [OR=2.355, 95%CI (1.256, 4.416), P=0.008], tumor sarcoma [OR=2.498, 95%CI (1.219, 5.120), P=0.012], and visceral resection [OR=2.008, 95%CI (1.042, 3.868), P=0.037] increased the probability of postoperative complications for the patients with RPT. The area under the receiver operating characteristic curve of the nomogram based on the risk factors in predicting the occurrence of postoperative complications was 0.704 [95%CI (0.626, 0.781), P<0.001]. The consistency index of the nomogram by internal verification was 0.704 [95%CI (0.628, 0.779)]. The calibration curve of the nomogram showed that the predicted value was basically consistent with the actual value, the Hosmer-Lemeshow goodness-of-fit test model had a good goodness-of-fit (χ2=3.407, P=0.906). ConclusionsFrom the results of this study, the tumor sarcoma, lower preoperative serum albumin, and visceral resection are associated with postoperative complications for patients with RPT. The nomogram based on risk factors has a good predictive value for postoperative complications.
PurposeTo analyze the effect of medication withdraw (MW) on long-term electroencephalogram (EEG) monitoring in children who need preoperative assessment for refractory epilepsy.MethodsRetrospective analysis was performed on the data of preoperative long-term EEG monitoring of children with refractory epilepsy who needed preoperative evaluation in the Pediatric Epilepsy Center of Peking University First Hospital from August 2018 to December 2019. Monitoring duration: at least three habitual seizures were detected, or the monitoring duration were as long as 10 days. MW protocol was according to the established plan.ResultsA total of 576 children (median age 4.4 years) required presurgical ictal EEGs, and 75 (75/576, 13.0%) needed MW for ictal EEGs. Among the 75 cases, 38 were male and 37 were female. The age range was from 15 months to 17 years (median age: 7.0 years). EEG and clinical data of with 65 children who strictly obey the MW protocol were analyzed. The total monitoring duration range was from 44.1 h (about 2 days) to 241.8 h (about 10 days)(median: 118.9 h (about 5 days)). Interictal EEG features before MW were including focal interictal epileptiform discharge (IED) in 39 cases (39/65, 60%), focal and generalized IED in 2 cases (2/65, 3.1%), multifocal IED in 20 cases (20/65, 30.7%), multifocal and generalized IED in 2 cases (2/65, 3.1%), and no IED in 2 cases (2/65, 3.1%). After MW, 18 cases (18/65, 27.7%) had no change in IED and the other 47 cases had changes of IED after MW. And IEDs in 46 cases (46/65, 70.8%) were aggravated, and IED was decreased in 1 case. The pattern of aggravated IED was original IED increasement, in 41 cases (41/46, 89.1%), and 5 cases (5 /46, 10.9%) had generalized IED which was not detected before MW. Of the 46 patients with IED exacerbations, 87.3% appeared within 3 days after MW. Habitual seizures were detected in 56 cases (86.2%, 56/65) after MW, and within 3 days of MW in 80.4% cases. Eight patients (14.3%) had secondary bilateral-tonic seizure (BTCS), of which only 1 patient had no BTCS in his habitual seizures. In 56 cases, 94.6% (53/56) had seizures after MW of two kinds of AEDs.Conclusions① In this group, thirteen percent children with intractable epilepsy needed MW to obtain ictal EEG; ② Most of them (86.2%) could obtain ictal EEG by MW. The IED and ictal EEG after MW were still helpful for localization of epileptogenic zone; ③ Most of the patients can obtain ictal EEG within 3 days after MW or after MW of two kinds of AEDs;4. The new secondary generalization was extremely rare.