General practice is a new discipline, and it is in common with evidence-based medicine for the features of “patient-centered” and “evidence-based”. Evidence-based medicine has spread in all fields of clinical practice, and it has been applied to different extents in many medical health and medical education fields including general practice. This paper aims to discuss and analyze the significance, modes and attentions of evidence-based general practice, so as to provide further references for promoting the practice of evidence-based general practice in China.
ObjectiveTo explore whether positive end-expiratiory pressure (PEEP) guided by the esophageal balloon manometry is better than the ARDS Network standard of care recommendations during treating traumatic acute respiratory distress syndrome (ARDS) patients with mechanical ventilation. MethodsTwelve traumatic ARDS patients selected from September 2013 to March 2015 in ICU of Xiamen No. 3 Hospital were administrated esophageal balloor catheter and underwent mechanical ventilation with PEEP adjusted according to measurements of esophageal pressure and the ARDS Network standard of care recommendations simultaneously. According to the selection method of PEEP, the patients were divided into two groups:the esophageal pressure guided group and the ARDS Network recommendations guided group (the control group). The changes of peak inspiratory pressure, esophageal pressure, transpulmonary end-expiratory pressure, transpulmonary end-inpiratory pressure, lung compliance at 0 h, 24 h, 48 h, 72 h following different PEEP treatments were observed and compared between two groups of patients. ResultsA mean PEEP in the esophageal pressure guided group of (10.98±4.36)cm H2O was significantly higher than the control group of (7.13±2.21)cm H2O (P<0.01). The transpulmonary end-expiratory pressure was significantly higher in the esophageal pressure guided group (0.71±0.62)cm H2O than the control group (-2.29±3.49) cm H2O. And all of the mean transpulmonary end-expiratory pressure remained above zero in the esophageal pressure guided group, whereas in the control group 73% patients remained negative (P<0.01). ConclusionsEsophageal pressure method adjusts PEEP for traumatic ARDS patients with mechanical ventilation through estimating pleural pressure so as to calculate transpulmonary pressure. It can identify traumatic ARDS patients who would benefit from the high PEEP, adjust PEEP individually and meet patients' need more satisfactorily.
ObjectiveTo evaluate the effects of leukocyte filtration (LF) on blood components and cytokines of residual pump blood after cardiopulmonary bypass (CPB). MethodsForty patients who underwent selective cardiac surgery with CPB in Fu wai Hospital from December 2012 to February 2013 were included in this study. There were 34 male and 6 female patients with their age of 16-72 years. All the patients were randomly divided into an experimental group and a control group. In the experimental group, patients received residual pump blood transfusion which had been processed with LF and stored in sterile blood collection bags. In the control group, patients received residual pump blood transfusion which was stored in sterile blood collection bags without LF process after CPB. Blood samples were taken before CPB (T1) at the end of CPB (T2) and 4 hours (T3) after CPB to examine blood components and concentrations of IL-6, IL-10 and TNF-α. ResultsWhite blood cell count and neutrophil count of the experimental group were significantly lower than those of the control group at T2 and T3 (P<0.05). There was no statistical difference in red blood cell count, hemoglobin,hematocrit or free hemoglobin at respective time points between the 2 groups (P>0.05). There was no statistical difference in plasma IL-6,IL-10 or TNF-α concentrations at different time points within either group (P>0.05) or at respective time points between the 2 groups (P>0.05). ConclusionLF can reduce white blood cell count and neutrophil count of residual pump blood,but does not significantly change other blood components and plasma concentrations of IL-6,IL-10 or TNF-α after CPB.
Objective To access the possibil ity of CPC as a suitable scaffold for tissue engineering artificial rib by morphologic observation, adhesion experiments and cellar prol iferation experiments. Methods The 5 mm × 5 mm × 5 mm CPCs were prepared and the structure and components of CPC were compared with those of the normal human bone by micro-CT and scanning electron microscope. Bone marrow aspirates were harvested from the young pig and monuclear cells were separated. The first passage cells were collected and re-suspended in the culture media at a density of 6 × 105 cells/mL. There was 150 μL suspension which was incoluated on the CPC, and then cells were recollected and counted 4, 12 and 24 hours after inoculation. MTT was used to examine the growth condition of BMSCs on the surface of CPC. The scanning electron microscope was used to observe the CPC scaffold 7 days after inoculation, and comparison was made with CPC and the normal human bone. Results The adhesion rate of CPC was 28.00% ± 0.98%, 46.70% ± 1.14% and 48.50% ± 1.18%, respectively 4, 12 and 24 hours after compound culture. The prol iferation rate of CPC was 1.103 ± 0.214, 1.557 ± 0.322, 1.920 ± 0.178, 2.564 ± 0.226, 2.951 ± 0.415 and 3.831 ± 0.328, respectively 1, 2, 3, 4, 5 and 6 days after compound culture, with an obvious rising trend. The micro-CT demonstrated that the content of hydroxyapatite of porous phosphate calcium was (1 101.222 8 ± 0.618 4) mg/ ccm while that of the normal human bone was (1 072.552 3 ± 0.744 2) mg/ccm, and the porosity of porous phosphate calcium was 70.26% ± 0.45% while that of the normal human bone was 72.82% ± 0.51%, and there was no significant difference (P gt; 0.05). The experiment of cell prol iferation showed that the cell which was cultivated with porous phosphate calcium prol iferated rapidly. Through the inverted phase contrast microscope, it was found that the cells grew well and there was no dead cell, which indicated that the material had no toxicity. The rate of the cell adhesion to CPC was less than 50%. Conclusion The structure and components of CPC are similar to those of the normal human bone, and BMSCs grow well on the surface of it, so it is asuitable scaffold for tissue engineering artificial rib. However, the cell adhesion abil ity is to be further improved.
ObjectiveTo investigate the effect of KLD-12 polypeptide complexed with recombinant human bone morphogenetic protein 2 (rhBMP-2) on osteogenic activity of rabbit bone marrow mesechymal stem cells (BMSCs). MethodsBone marrow was harvested from 3-month-old New Zealand white rabbit, and density gradient method was used to isolate and culture BMSCs. The third generation BMSCs were used for three-dimensional culture of KLD-12 polypetide/rhBMP-2 in vitro (experimental group) and KLD-12 polypeptide (control group). The morphology of the cells in the gel was observed by inverted phase contrast microscope at 7 days; alkaline phosphatase (ALP) and osteocalcin protein content were dectected at 3, 7, 10, 14, and 21 days; collagen type I immunofluorescence staining was done and real-time fluorescent quantitative PCR was performed to detect the relative expression of collagen type I and osteocalcin gene at 14 days. ResultsUnder the inverted phase contrast microscope, the BMSCs in the gel of the experimental group and the control group showed circular growth, and the distribution was uniform at 7 days. There was no significant difference in the expressions of ALP and osteocalcin protein content between 2 groups at 3 and 7 days (P > 0.05); the above indexes in experimental group were significantly higher than those in the control group at 10-21 days (P < 0.05). Laser scanning confocal microscope observation showed that immunofluorescence staining for collagen type I was positive in the experimental group, and the expression was higher than that in the control group at 14 days. Real-time fluorescence quantitative PCR detection showed that the collagen type I and osteocalcin gene expressions were significantly higher than those in the control group (t=15.902, P=0.000; t=12.998, P=0.000). ConclusionBMSCs can normally grow and proliferate in the KLD-12 polypeptide, and KLD-12 polypeptide/rhBMP-2 has good biological activity to induce BMSCs differentiation into osteoblasts.
ObjectiveTo investigate the short-term follow-up results of inflatable mediastinoscopy combined with laparoscopy in the treatment of esophageal cancer.MethodsClinical data of 102 patients with esophageal cancer who underwent minimally invasive esophagectomy were enrolled in our hospital from January 2017 to January 2019. Patients were divided into two groups according to different surgical methods, including a single-port inflatable mediastinoscopy combined with laparoscopy group (group A, n=59, 53 males and 6 females, aged 63.3±7.6 years, ranging from 45 to 75 years) and a video-assisted thoracoscopy combined with laparoscopy group (group B, n=43, 35 males and 8 females, aged 66.7±6.7 years, ranging from 50-82 years). The short-term follow-up results of the two groups were compared.ResultsCompared with the group A, the rate of postoperative pulmonary complication of the group B was significantly lower (18.64% vs. 4.65%, P<0.05). There was no significant difference between the two groups in other postoperative complications (P>0.05). The 6-month, 1-year, and 2-year survival rates were 96.61%, 89.83%, and 73.33%, respectively in the group A, and were 95.35%, 93.02%, and 79.17%, respectively in the group B. There was no significant difference in short-term survival rate after operation (P>0.05).ConclusionIn the treatment of esophageal cancer, the incidence of pulmonary complications of inflatable mediastinoscopy combined with laparoscopy is lower than that of traditional video-assisted thoracoscopy combined with laparoscopy, and there is no significant difference in other postoperative complications or short-term survival rate between the two methods. Inflatable mediastinoscopy combined with laparoscopy for radical esophageal cancer is a relatively safe surgical method with good short-term curative effects, and long-term curative effects need to be further tested.
ObjectiveTo explore the effectiveness of minimally invasive clamp reduction technique via anterior approach in treatment of irreducible intertrochanteric femoral fractures.MethodsBetween January 2015 and January 2019, 59 patients with irreducible intertrochanteric femoral fractures were treated with minimally invasive clamp reduction technique via anterior approach. There were 29 males and 30 females with an average age of 77.9 years (range, 45-100 years). The causes of injury included falling in 46 cases, traffic accident in 6 cases, smashing in 2 cases, and falling from height in 5 cases. The time from injury to operation was 1-14 days (mean, 3.8 days). The fractures were classified as AO type 31-A1 in 12 cases, type 31-A2 in 25 cases, type 31-A3 in 22 cases.ResultsAll fractures were reduced well and the fracture reduction took 10 to 30 minutes, with an average of 19 minutes. All patients were followed up 13-25 months, with an average of 17.6 months. Among them, 2 cases of pronation displacement of proximal fracture segment died for infection or falling pneumonia after internal fixation failed. Six patients with reversed intertrochanteric femoral fractures experienced re-pronation and abduction displacement of the lateral wall after internal fixation, but the fractures all healed. The rest of the patients had no fracture reduction loss, and the fractures healed with an average healing time of 5.9 months (range, 3-9 months). Except for 2 patients who died, the Harris score of hip joint function of the remaining 57 patients was excellent in 49 cases and good in 8 cases at last follow-up.ConclusionThe minimally invasive clamp reduction technique via anterior approach for irreducible intertrochanteric femoral fractures is simple and effective. For irreducible intertrochanteric femoral fractures related to lateral wall displacement, after clamp reduction and intramedullary nail fixation, the lateral wall should be reinforced in order to avoid reduction loss and internal fixation failure.