ObjectivesTo explore the association between liver dysfunction and premature birth (PTB).MethodsA prospective cohort of HBV-infected or uninfected pregnant women of Han nationality attending antenatal care at Nantong Maternal and Child Health Hospital was recruited from January 1st, 2012 to June 30th, 2016. Liver function tests (LFTs) were monitored through pregnancy. Robust Poisson regression was used to estimate adjusted risk ratios (RRs) on HBV infection and LFT abnormalities.ResultsAmong 35 452 pregnant women (1 073 HBV carriers and 34 379 non-HBV women), 4 266 (12.03%) had at least one instance of abnormal LFT results. One fold upper limit of normal aspartate aminotransferase (AST), two folds upper limit of normal total bilirubin, and four folds upper limit of normal total bile acid rather than HBsAg positivity, were identified as independent risk factors for PTB by Robust Possion regression analysis.ConclusionsAbnormal LFTs among pregnant women is an independent risk factor of PTB. We suggest monitoring the LFTs results of high-risk population throughout pregnancy.
Objective To explore the effect of the intensive CT on the deep inferior epigastric perforator (DIEP) flap design strategy. Methods From June 2007 to March 2008, 7 patients received reconstructive operation of the vertical DIEP flap, among whom there were 5 females with congenital absence of vagina and 2 males with peno-scrotal Paget’s disease,aged 18-62 years old. Before the operation, the intensive CT scans were appl ied to all the petients in search for DIEP. The flaps were designed according to the radiological findings. The scrotum and penis defects were reconstructed in 2 cases and vaginal reconstruction was performed in 5 cases. The flap dimension ranged from 15 cm × 7 cm to 22 cm × 5 cm. The donor site was closed directly. Results A total of 10 ideal perforating branches of all the 7 DIEP flaps were found before the operation, with the diameter of over 1.5 mm. Of the 7 flaps, 4 had 1 perforating branch and the other 3 had 2 perforating branches. All 7 flaps survived completely. The incisions of 6 patients obtained heal ing by first intention. Only 1 patient with Paget’s disease had erosion at the scrotum incision and partial necrosis 7 days after the operation, and then healed after discontinuous dressing change. The incisions at the donor site obtained heal ing by first intension. Two patients complained about draw-off at the lower abdomen on the operated side, which was basically rel ieved at 7 days after the operation. All patients were followed up for 1 to 10 months (4.5 months on average). No operation-related compl ication was observed after operation. Six patients were satisfied with the reconstructive results. Only 1 patient was dissatisfied with the buried pennies and requested a revision. Conclusion The intensive CT scans play an important role in the DIEP flap design. It can not only make the flap safer, but also decrease operation time and improve efficiency.
ObjectiveTo evaluate the method quality of systematic reviews/Meta analysis published in nursing journals. MethodsWe retrieved Chinese Biomedical Literature Database, Chinese academic literature online publishing pool and Chinese Scientific Journals Database (the duration was from the beginning to August, 2013). The systematic reviews and Meta analysis published in nursing journals were included, and were evaluated by 10 items in OQAQ (Oxman-Guyatt Overview Quality Assessment Questionnaire). ResultsA total of 74 literatures were included in the analysis, including 17 systematic reviews and 57 Meta-analyses. It showed that the mean OQAQ score was 2.92±1.63. About 4.1%, 8.1%, 31.1%, 43.2%, 29.7%, 55.4%, 16.2%, 37.8%, and 60.8% studies stated literature research methods used to find evidence; had reasonably comprehensive search; avoided bias in the selection of studies by duplicate screening; reported the criteria used for assessing the validity of the included studies; concluded the findings by the data or analysis; provided a list of studies; assessed using appropriate criteria; reported the methods used to synthesis the findings; and combined the findings of the included studies appropriately. ConclusionThe systematic reviews/Meta analysis of the overall quality in nursing field is low. The search strategy, inclusion and exclusion criteria, quality assessment and data analysis is particularly prominent, researchers should conduct rigorous methodological training.
ObjectiveTo explore the feasibil ity and rel iabil ity of rib-sparing technique for internal mammary vessels exposure and anastomosis in breast reconstruction and thoracic wall repair with deep inferior epigastric perforator (DIEP) flaps. MethodsBetween November 2009 and September 2011, 11 female patients with post-mastectomy deformities were treated. The mean age was 42 years (range, 33-65 years). Of them, 10 patients underwent breast reconstruction with the DIEP flaps, and 1 patient received defect repair for chronic thoracic wall irradiated ulcer with the DIEP flap. The size of the flap ranged from 18 cm×9 cm to 28 cm×12 cm. Rib-sparing technique was applied in all these cases. The internal mammary vessels were exposed by dissection intercostal space and anastomosed with the deep inferior epigastric vessels. The donor sites were closed directly in all cases. ResultsIn all cases, the rib-sparing technique for internal mammary vessels exposure and anastomosis was successfully performed. The mean time for internal mammary vessels exposure was 52 minutes (range, 38-65 minutes). The mean exposure length of the internal mammary vessels was 1.7 cm (range, 1.3-2.2 cm). All flaps survived completely postoperatively, and wounds and incisions at donor sites healed primarily. All patients were followed up 8-26 months (mean, 12 months). All patients were satisfied with the reconstructive outcomes. No collapse deformity or discomfort of the thoracic wall occurred. ConclusionThe rib-sparing technique for internal mammary vessels exposure and anastomosis is a rel iable and reproducible approach to reconstruct the breast and repair the thoracic wall with DIEP flap, and it can reduce collapse deformity of the thoracic wall.
Objective To analyze features of color Doppler ultrasonography in gastrointestinal stromal tumors. Method The ultrasound images of gastrointestinal stromal tumors (51 cases) and gastrointestinal cancers (59 cases) confirmed by operation and pathology were compared and analyzed. Results The gastric stromal tumor mainly occurred at the bottom of the stomach and the body of the stomach (17 cases), the intestinal stromal tumor mainly occurred at the small intestine (24 cases). The gastric cancer mainly occurred at the gastric antrum (18 cases), the intestinal cancer all occurred at the colon (20 cases) and rectum (12 cases). Compared with the gastrointestinal cancers, the gastrointestinal cavity was not surrounded by tumor, the peripheral boundary was clear, the morphology was more regular, the internal echo was uneven, and there was no peripheral lymph node metastasis in the gastrointestinal stromal tumors, the differences were statistically significant (P<0.05). There were no significant differences in the degree of blood flow and tumor diameter between the gastrointestinal stromal tumors and the gastrointestinal cancers (P>0.05), but the blood flow of the intestinal stromal tumor was significantly more abundant as compared with the intestinal cancer (P<0.05). Conclusion Color Doppler ultrasonography, as a simple and rapid method, has a certain diagnostic value for differentiation of gastrointestinal stromal tumors and gastrointestinal cancers.
ObjectivesTo estimate the latest burden of disability adjusted life years (DALYs) for liver cancer in China and the long-term trend, and to make future prediction.MethodsBased on the visualization platform of Global Burden of Disease 2016, data on the DALYs for liver cancer in China was extracted. The very recent status in 2016 and the previous trend from 1990 to 2016 were described, using annualized rate of change (ARC). The burden from 2017 to 2050 was further predicted by combining the ARC and the Chinese population data projected by the United Nation.ResultsIn 2016, the total DALYs for liver cancer in China was estimated as 11 539 000 person years (accounting for 54.6% of the global burden), and years of life lost (YLLs) and years lived with disability (YLDs) contributed 98.9% and 1.1%, respectively. The age-standardized DALY rate was 844.1 per 100 000 (3.0 times of the global average) and the male-to-female ratio was 3.4. The DALY rate continuously increased from 1990–2016 (ARC=0.57%), particularly in recent 5 years (ARC=1.75%). Among the DALYs for all cancers, liver cancer contributed approximately 20% and constantly remained as the top 2 (ranking as the number one before year 2005). There were inverse trends in gender, with increasing in males and decreasing in females (ARC was 0.77% and –0.11%, respectively). Hepatitis B infection continually kept the leading cause of DALYs for liver cancer (accounting for nearly 57%), and the DALY rate was gradually increasing (ARC=0.43%). Although the peak age of DALY rate was stable at 65to 69 years, the peak age of the DALYs changed from 55 to 59 years in 1990 to 60 ~ 64 years in 2016. In 2050, the estimated DALYs for liver cancer in China will reach 14.37 million person years, 20.0% more than that in 2017.ConclusionsThe DALYs caused by liver cancer in China exceeds the overall burden of all other countries in the world, and accounts for 1/5 of DALYs for all cancers in local population. The burden in males has been continuously rising, and the leading cause remained unchanged as hepatitis B infection. With population aging, the DALYs for liver cancer in China will be incessant to increase, suggesting the necessity to implement continuous effort in risk factors prevention (e.g. hepatitis B infection), and efficient management in high risk population of liver cancer.