ObjectivesTo analyze prospective incidence and risk factors of urolithiasis after Topiramate (TPM) therapy in epileptic patients. MethodsWe prospectively analyzed the incidence of urolithiasis in 120 patients with epilepsy who diagnosed in the Department of Neurology of the First Hospital Affiliated to Dalian Medical University from March 2004 to March 2013. Then calculated the incidence of urolithiasis, and analyzed the risk factors. ResultsIn the 120 cases we collected, male accounted for 74, female accounted for 46. After treated with TPM, the incidence of urolithiasis was 18.3%. All of urolithiasis were kidney stones. The stones caused by TPM were mostly single and small, most of which would disappear spontaneously after discontinuation of the medication. The incidence of asymptomatic urolithiasis was 3.4 times to that of symptomatic urolithiasis. The development of urolithiasis had no correlation with the dose of TPM and duration. Urolithiasis frequently occurred in epilepsy patients in the age over 20 or symptomatic epilepsy or duration of combined medication≥3 months. ConclusionsThe incidence of urolithiasis in epilepsy patients was 18.3% after initiating TPM therapy. The stones would disappear spontaneously after discontinuation of the medication. The development of urolithiasis had no correlation with the dose of topiramate and duration.
目的探讨全胸腔镜辅助房间隔缺损封堵术治疗房间隔缺损的可行性及体会。 方法2012年1月至2013年12月福建医科大学附属协和医院心外科收治房间隔缺损患者28例，其中男10例、女18例，年龄15～45（30.5±12.9）岁。采取全胸腔镜辅助，使用特殊的输送鞘管，将封堵伞嵌入房间隔缺损处将其封闭，反复推拉封堵伞无移位，超声检查提示房水平无残余分流、对周围各重要结构无影响后释放封堵器，术后分别采用心脏彩色超声心动图、心电图及胸部X线片评价治疗效果。 结果28例封堵成功。手术时间58～100 min，心内封堵操作时间5～10 min，住ICU 2 h至1 d，住院时间3～7 d。3例患者出现围手术期心律失常，包括室上性心动过速、心房扑动，经药物处理后短时间内恢复正常；1例术后少量胸腔积液未予特殊处理。随访3～12个月，无封堵伞移位、无残余分流及血栓等相关并发症发生。 结论全胸腔镜辅助房间隔缺损封堵术是安全有效的，易于临床推广。
Objective To investigate the methods and effectiveness of multi ple surgical treatment for complex aortic arch and descending aorta disease, including cardiopulmonary bypass operation, hybrid operation, and total endovascular aneurysm repair (EVAR). Methods Between October 2006 and September 2011, 48 patients with complex aortic arch anddescending aorta disease were treated. There were 31 males and 17 females, aged from 28 to 81 years (mean, 52.4 years). The disease duration ranged from 1 to 90 days (mean, 10.2 days). There were 30 cases of type B aortic dissection involving the aortic arch, 11 cases of thoracic aortic aneurysm, 3 cases of thoracic pseudoaneurysme, 3 cases of penetrating aortic ulcer, and 1 case of aortoesophageal fistula. Cardiopulmonary bypass operation, hybrid operation, and total EVAR were performed in 15, 12, and 21 cases, respectively. Results In the patients undergoing cardiopulmonary bypass operation, the following complications occurred: 1 case of bleeding, 1 case of coma, 3 cases of psychiatric disorders, 4 cases of pneumonia, 2 cases of acute renal insufficiency, and 2 cases of multi-organ dysfunction; finally 3 patients died. In the patients undergoing hybrid operation, cerebral infarction and renal function failure occurred in 1 case. In the patients undergoing total EVAR, no complication occurred. A total of 41 patients were followed up 2 to 60 months (mean, 28.6 months). Sl ight left subclavian steal syndrome occurred in 3 cases, but self rel ieved. Other patients recovered to normal l ife. Conclusion In the surgical treatments of complex aortic arch and descending aorta disease, cardiopulmonary bypass operation will be gradually replaced by EVAR because of the surgical trauma and risk, hybrid operation is an important technique, and total EVAR will be the future progress.
ObjectiveTo systematically review therapy-related complications incidences of warfarin with different anticoagulation intensity in Chinese after mechanical heart valve replacement, and to explore the suitable anticoagulation intensity of warfarin. MethodsWe electronically searched The Cochrane Library (Issue 2, 2013), EMbase, PubMed, CNKI, CBM, WanFang Data and VIP for studies about therapy-related complications rates of warfarin with different anticoagulation intensity in Chinese after mechanical heart valve replacement from inception to March 2013. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 7 studies involving 3 787 cases were finally included, 2 985 cases in Group A (targeted INR≤2.3) and 802 cases in Group B (targeted INR > 2.3). The results of meta-analysis showed that, compared with Group B, the total therapy-related complications incidence of warfarin with different anticoagulation intensity significantly decreased in Group A (OR=0.35, 95%CI 0.28 to 0.44, P < 0.000 01). The incidence of hemorrhage in Group A (OR=0.15, 95%CI 0.08 to 0.27, P < 0.000 01) was lower than that in Group B. However, the incidence of embolism in Group A was higher than that in Group B (OR=2.77, 95%CI 1.54 to 4.98, P=0.000 7). ConclusionApplying low-intensity anticoagulation for Chinese patients after mechanical heart valve replacement could reduce the overall incidences of anticoagulation-related complications and hemorrhage, but it could also significantly increase the incidence of thrombosis.
Wound infection can prolong wound healing time, increase hospitalization cycle and readmission rate, seriously affect patients’ quality of life and increase economic expenditure. Timely and accurate identification and management of wound infections is key to promoting wound healing and maximizing cost-effective management. In 2022, the International Wound Infection Association published the third edition of Wound Infection in Clinical Practice: Principles of Best Practice. The consensus incorporates new advances in research and clinical practice in the areas of wound environment, risk factors for infection, biofilms, antibiotic resistance, and the identification and management of wound infections, and provides detailed approaches to infection assessment and management. This article introduces the key elements of the 2022 expert consensus and interprets the updated content to help healthcare professionals, patients, caregivers, and policy makers understand the latest consensus document, promote its clinical application in the prevention and treatment of wound infection, and better improve the quality of clinical practice.
This article interprets the core updated content of WHS Guidelines for the Treatment of Pressure Ulcers-2023 update compared to Wound Healing Society 2015 update on Guidelines for Pressure Ulcers in multiple key areas, including posture and support surface, infection, wound bed preparation, surgical treatment, and adjuvant therapy. Additionally, the article deeply interprets the new content of the 2023 updated guidelines (palliative wound care for patients with severe pressure ulcers), in order to provide efficient and convenient reference tools for domestic medical personnel to quickly grasp the latest developments in pressure ulcer treatment, standardize treatment processes, and improve treatment effectiveness.
Objective To summarize the cl inical experience of vascular bypass grafting combined with endovascularaortic repair (EVAR) for aortic dilatation disease. Methods Between January 2008 and August 2011, 12 patients with aorticdilatation disease were treated with vascular bypass grafting combined with EVAR. Of 12 patients, 11 were male and 1 wasfemale, aged 47-81 years (mean, 65.9 years). All cases were diagnosed through computed tomography angiography (CTA),including 1 case of Stanford type A dissection, 5 cases of Stanford type B dissection, 4 cases of aortic arch aneurysm, and 2 casesof abdominal aortic aneurysm. Eight patients received neck artery bypass grafting before EVAR, and 4 patients underwentfemoral artery bypass grafting after EVAR. Results After operation, pulmonary infection occurred in 3 patients, renalinsufficiency in 2 patients, cerebral infarction in 1 case, decreased hemoglobin and platelets in 7 cases, and poor healing of groinwound in 1 case. Eleven patients were followed up 3-42 months, with an average of 18.6 months. In 1 case undergoing EVARof the thoracic and abdominal aorta, EVAR was performed again because new aneurysms formed at 6 months after operation,and the patient achieved good recovery after 3 months. CTA showed reduced false lumen, thrombosis formation, no endoleak,no deformation or displacement of stent, and anastomotic patency of artificial blood vessels in the other patients at 3, 6, and12 months after operation. Conclusion Vascular bypass grafting combined with EVAR can expand the indications forendovascular repair. It not only provides sufficient anchoring area, but also ensures the blood supply to vital organs, simplifiesthe surgical procedure, and reduces the difficulty of endovascular treatment.