目的:探讨经后腹腔镜手术治疗直径≥6.0cm的肾上腺肿瘤的安全性和效果。方法:对我院近5年收治经后腹腔镜手术治疗的直径≥6.0cm肾上腺肿瘤患者的临床资料进行回顾分析,27例患者年龄24～76岁,男性10例,女性17例,肿瘤直径6.0～8.5 cm。病理结果为:髓质脂肪瘤9例,肾上腺皮质腺瘤7例,肾上腺嗜铬细胞瘤6例,节细胞神经瘤3例,肾上腺皮质腺癌1例,肾上腺转移瘤1例。结果:24例患者顺利切除肿瘤,另外3例患者术中转开放手术,平均手术时间(119.46±36.65) min,术中估计出血量(80.14±36.48) mL,术后进食时间(1.88±0.82) d,术后引流管留置时间(2.05±0.65) d,术后住院时间(6.21±1.84) d。 结论:在技术熟练的前提下,直径≥6.0 cm的肾上腺肿瘤经后腹腔镜手术治疗仍然安全、微创。
ObjectiveTo explore the clinical treatment measures and etiology analysis of lower urinary tract and penile foreign bodies. MethodsWe retrospectively analyzed the etiology and diagnosis of 48 cases of lower urinary tract and penile foreign body in the Department of Urology of our hospital between 1993 and 2012. ResultsNine bladder foreign bodies were removed successfully by using cystoscopy; nine were removed through suprapubic cystotomy; urethral foreign bodies in 10 patients were successfully taken out by urethrascope; five foreign bodies were extracted by hand and forceps; rubber bands in 2 patients were cut off under local anesthesia; fretsaw was used to cut through the nested rings in 7 patients; dental drill was used to cut nesting materials in 3 patients; and 3 patients underwent penis skin circumcision overturn stripping ring extraction. No complications after urethral foreign body extraction occurred. ConclusionThe lower urinary tract and penile foreign bodies are easy to diagnose, but patients often conceal the etiology, so the natural history collection is very important in the diagnosis, and doctors should take appropriate methods to remove the foreign body after the diagnosis is confirmed.
ObjectiveTo investigate the incidence of medical adhesive-related skin injuries (MARSI) and analyze its influencing factors among elderly patients, in order to provide reference for its prevention. MethodWe carried out a cross-sectional descriptive study in the Department of Geriatrics of a class-3 grade A hospitals in Sichuan Province between June 1 and July 31, 2015. Totally, 288 patients aged from 62 to 95 years [with the average of (82±13) years] met the inclusion criteria of the study. We analyzed the MARSI situation of the patients, and at the same time, we surveyed 126 nursing workers on their knowledge about MARSI. ResultsThe number of patients with MARSI was 37, and the incidence was 12.85%. The difference of Braden scores between patients with and without MARSI was statistically significant (P<0.001) . About 70% of the nursing staff knew little about MARSI. ConclusionsWe should pay attention to MARSI, improve nurses' knowledge and explore scientific preventive measures.
ObjectivesTo systematically review the efficacy and safety of doxazosin for ureterolithiasis.MethodsPubMed, EMbase, Web of Science, The Cochrane Library and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of comparing doxazosin with conservative treatment or tamsulosin for ureterolithiasis from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, RevMan 5.3 software was used to perform meta-analysis.ResultsA total of 15 RCTs involving 1 062 patients were included. The results of meta-analysis showed that: compared with conservative treatment, doxazosin significantly facilitated ureteral stone expulsion (RR=1.62, 95%CI 1.45 to 1.81, P<0.000 01). No statistical significant difference was found in stone-free rate (RR=0.96, 95%CI 0.83 to 1.11, P=0.57), stone expulsion time (SMD=−0.17, 95%CI −0.52 to 0.19, P=0.35) or pain episode frequency (SMD=0.21, 95%CI −0.15 to 0.56, P=0.25) between doxazosin and tamsulosin. Treatment-associated serious side effects were rarely reported.ConclusionCurrent evidence shows that doxazosin is an efficient and safe medical expulsion agent for ureterolithiasis management. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To systematically review the efficacy of chlorhexidine versus povidone iodine in the prevention of wound infections after surgeries by meta-analysis. Methods All randomized controlled trials comparing these two disinfectants were searched from databases of PubMed, The Cochrane Library (Issue 3, 2016), EMbase, WanFang Data, VIP and CNKI from inception to August 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 14 randomized controlled trials were included. The results of meta-analysis showed that the chlorhexidine group had significantly lower rates in any surgical site infection (RR=0.71, 95% CI 0.58 to 0.88,P=0.001) and superficial incisional infection (RR=0.66, 95% CI 0.48 to 0.91,P=0.01) when compared with povidone iodine group. However, there were no significant differences in deep incisional infection (RR=0.51, 95% CI 0.23 to 1.11,P=0.09) and organ-space infection (RR=0.97, 95% CI 0.53 to 1.76,P=0.92) between the two groups. Furthermore, subgroup analysis revealed differences in any surgical site infection and superficial incisional infection could only be found in surgeries possibly contaminated. Conclusion Chlorhexidine may be superior in decreasing the incidence of infection in probably contaminated surgery.
Objective To observe the effect of tetramethypyrazine (TMP) on the expression of hypoxia-related factors in human umbilical vein endothelial cells (HUVECs). Methods The second to fifth passage cultured HUVECs were divided into five groups: control group, CoCl2induced hypoxic group and 50, 100, 200 mu;mol/L TMP treatment groups. HUVECs in control group were not treated. HUVECs inCoCl2induced hypoxic group were treated with 150 mu;mol/LCoCl2for four hours. HUVECs in 50, 100, 200 mu;mol/L TMP treated groups were pretreated with 150 mu;mol/LCoCl2 for four hours, followed by treatment with 50, 100, 200 mu;mol/L TMP for eight hours. Real-time reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the mRNA levels of prolyl hydroxylase 2 (PHD2), hypoxia-induced factor-1alpha;(HIF-1alpha;) and vascular endothelial growth factor (VEGF). Protein levels of PHD2, HIF-1alpha;, and VEGF were detected using Western blot. Results Compared with the control group, theCoCl2 induced hypoxic group showed decreased mRNA and protein levels of PHD2 (t=3.734, 3.122;P＜0.05), while those of HIF-1alpha; and VEGF increased (HIF-1alpha; mRNA:t=4.589,P＜0.05; HIF-1alpha; protein:t=3.778,P＜0.05. VEGF mRNA:t=3.926,P＜0.05; VEGF protein:t=3.257,P＜0.05). Compared with theCoCl2 induced hypoxic group, 50, 100, 200 mu;mol/L TMP treated groups showed increased mRNA and protein levels of PHD2 (PHD2 mRNA: t=3.286, 3.617, 3.886;P＜0.05. PHD2 protein: t=2.813, 3.026, 3.078; P＜0.05); while those of VEGF decreased (VEGF mRNA: 50 mu;mol/L TMP: t=1.696,P＞0.05; 100 mu;mol/L TMP:t=2.974,P＜0.05; 200 mu;mol/L TMP: t=3.492,P＜0.05; VEGF protein: 50 mu;mol/L TMP: t=1.986,P＞0.05; 100 mu;mol/L TMP: t=2.976,P＜0.05; 200 mu;mol/L TMP:t=3.136,P＜0.05); although changes in HIF-1alpha;mRNA levels were not statistically significant (t=1.025, 0.726, -1.386;P＞0.05), showed a decrease in HIF-1alpha;protein levels (50 mu;mol/L TMP: t=2.056,P＞0.05; 100 mu;mol/L TMP:t=3.058,P＜0.05; 200 mu;mol/L TMP:t=3.828,P＜0.05). ConclusionIn HUVECs, TMP can upregulate the mRNA and protein expression of PHD2, while down regulating HIF-1alpha; protein expression and VEGF mRNA and protein expression under acute hypoxic conditions.
ObjectivesTo systematically review the clinical efficacy and safety of antipsychotics for delirium. MethodsDatabases including The Cochrane Library (Issue 5, 2015), PubMed, MEDLINE, EMbase, CNKI, VIP and WanFang Data were electronically searched for randomized controlled trials (RCTs) about antipsychotics compared with placebo/blank for delirium from inception to May 2015. We also hand-searched related conference proceedings and references of included studies for additional studies. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was conducted by using RevMen 5.3 software. ResultsA total of 7 RCTs involving 712 patients were included. The results of meta-analysis showed that there were no significant differences between the antipsychotics group and the placebo/blank group in mortality (RR=1.00, 95%CI 0.90 to 1.10, P=0.99), duration of delirium (MD=-1.53, 95%CI -4.95 to 1.89, P=0.38), length of stay (MD=-0.89, 95%CI -7.69 to 5.90, P=0.80), and ICU stay time (MD=-3.70, 95%CI -15.83 to 8.43, P=0.55). Compared with the placebo/ blank group, the antipsychotics could reduce the severity of delirium (SMD=-1.62, 95%CI -2.32 to -0.93, P<0.000 01). ConclusionCurrent evidence shows that the efficacy of antipsychotics in the treatment of delirium is not clear. Due to the limited quantity and quality of the included studies, the above conclusion needs to be further verified by more high quality studies.
ObjectiveTo study the expression of cytokine-induced neutrophil chemoattractant-1(CINC-1)in rats with transfusion-related acute lung injury(TRALI),explore its possible role in the pathogenesis of TRALI. MethodsSixty Sprague-Dawley rats were randomly divided into a normal control group with sham operation,a positive control group with ALI induced by intravenous infusion of lipopolysaccharide(5 mg/kg),and a TRALI group treated by intraperitoneal injection of LPS 2h before the transfusion of human plasma (1mL),a LPS control group treated by intraperitoneal injection of LPS 2h before the transfusion of normal saline(1mL).The reverse transcription-polymerase chain (RT-PCR)was used to detect CINC-1 mRNA.The level of CINC-1 in lung tissue homogenate was measured by ELISA.Morphological changes of the lung tissue were observed under light microscope.Myeloperoxidase (MPO)in lung homogenate and wet lung weight to dry lung weight ratio (W/D)were observed.The number of cells and the percentage of polymorphonuclear neutrophil (PMN)in Bronchoalveolar lavage fluid (BALF)were also compared. ResultsCompared with the normal control group and the LPS control group,the expression of CINC-1 protein and CINC-1 mRNA were increased significantly in lung of the positive control group and the TRALI group(P<0.05).The number of cells and the percentage of PMN in BALF of the TRALI group [(310.63±76.67)×106/L and (33.57±11.51)%] were significantly higher than those in BALF of the normal control group [(101.36±63.83)×106/L and (9.87±3.56)%](P<0.05).Tissue water content and MPO activity in the TRALI group were significantly higher than those in the normal control group (P<0.05). ConclusionExpression of CINC-1 protein and CINC-1 mRNA are increased in the rat lung with TRALI and PMN infiltration in lung tissue,which suggests CINC-1 participate in the process of the PMN and endothelial cell adhesion and may play an important role in the pathogeneses of TRALI.
Objective To investigate the effect of adductor canal block combined with local infiltration anesthesia on the rehabilitation of primary total knee arthroplasty (TKA). Methods A total of 104 patients who met the selection criteria for the first unilateral TKA between March 2017 and August 2017 were included in the study. They were randomly divided into trial group (53 cases) and control group (51 cases). In the trial group, the adductor canal block with intraoperative local infiltration anesthesia were performed. In the control group, only intraoperative local infil-tration anesthesia was performed. There was no significant difference in gender, age, body mass index, diagnosis, effected side, and the preoperative American Society of Anesthesiologists (ASA) grading between 2 groups (P>0.05). The operation time, length of stay, and complications were compared between 2 groups, as well as visual analogue scale (VAS) score of incision at rest and during activity, the range of motion (ROM) of knee flexion and extension activity, limb swelling (thigh circumference), walking distance, and pain VAS score while walking. Results The operation time of the trial group was significantly shorter than that of the control group (t=–2.861, P=0.005). However, there was no significant difference in length of stay between 2 groups (t=–0.975, P=0.332). The wound effusion occurred in 1 patient of trial group and 2 of control group; hematoma occurred in 2 patients of trial group and 3 of control group; no symptom of intermuscular venous thrombosis occurred in 1 patient in each of 2 groups; ecchymosis occurred in 14 patients of trial group and 15 of control group; there was no significant difference in the incidence of related complications between 2 groups (P>0.05). There was no significant difference in the preoperative VAS score at rest and during activity, ROM of knee flexion and extension activity, and thigh circumference between 2 groups (P>0.05). However, there were significant differences in the VAS score at rest and during activity after 2, 4, 8, and 12 hours, ROM of knee flexion and extension activity after 1 and 2 days, and the walking distance on the day of discharge, pain VAS scores while walking after 1 and 2 days and on the day of discharge, and thigh circumference after 1 day between 2 groups (P<0.05). Conclusion For the primary TKA, the adductor canal block combined with local infiltration anesthesia can early relieve the initial pain of the incision, shorten the operation time, and promote the mobility and functional recovery of the knee joint.