ObjectiveTo systematically review the effect and safety of continuous veno-venous hemofiltration (CVVH) on patients with hyperlipidemic pancreatitis. MethodsDatabases including the Cochrane Library (Issue 2, 2014), PubMed, EMbase, CBM, CNKI and WanFang Data were electronically searched for randomized controlled trials (RCTs) about CVVH on patients with hyperlipidemic pancreatitis till Feb. 12, 2014. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of included studies was also assessed. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 7 trials met eligibility criteria, involving 360 cases, including 183 cases of CVVH group and 177 cases of control group. The results of meta-analysis showed that compared with only routine medical treatment, CVVH significantly reduced the levels of lipid (WMD=-4.63, 95%CI-5.98 to-3.27, P < 0.000 01), levels of IL-6 (WMD=-29.59, 95%CI-34.30 to-24.89, P < 0.000 01), overall mortality (RR=0.39, 95%CI 0.18 to 0.84, P=0.02), and APACHE II score (WMD=-3.34, 95%CI-5.12 to-1.56, P=0.000 2) after treatment. ConclusionCVVH is more effective for hyperlipidemic pancreatitis than only routine medical treatment. Due to the limited quantity and quality of the included studies, further high-quality, multicenter, large-scale RCTs are required to verify the above conclusion.
In this paper, the Fourier transform based minimum mean square error (FT-based MMSE) method is used to calculate the regional cerebral blood volume (rCBV) in magnetic resonance (MR) perfusion imaging, and the method is improved to handle the existing noise in the imaging process. In the experiments with signal-to-noise ratio (SNR) of 50 dB, the rCBV values were compared with the results using MMSE method. The effects of different SNRs on the estimation of rCBV were analyzed. The experimental results showed that MMSE was a simple way to filter the measurement noise, and could calculate rCBV accurately. Compared with other existing methods, the present method is not sensitive to environment, and furthermore, it is suitable to deal with the perfusion images acquired from the environment with larger SNR.
ObjectiveTo explore the effectiveness of levosimendan versus dobutamine for the patients with severe valvular disease in perioperative period. Methods A randomized, single-blind, and controlled study was conducted in 59 patients with severe valvular disease in perioperative period. There were 48 males and 11 females at average age of 51±14 years (ranged from 18 to 70 years). The patients received Swan-Ganz catheterization with pulmonary capillary wedge pressure (PCWP)≥15 mm Hg, cardiac index (CI)≤2.5 L/(min·m2), and hemodynamic stability. They were divided into a levosimendan group (n=25) and a dobutamine group (n=34) to receive levosimendan or dobutamine injection intravenously for 24 hours on base of anti-heart failure treatment by random digital table. ResultsIn the levosimendan group, the level of PCWP was lower than the baseline level with a statistical difference(12.51±8.76 mm Hg vs. 20.11±8.04 mm Hg, P < 0.01) after 24 hours' treatment, and the level of CI was higher than the baseline level with a statistical difference (2.58±0.72 L/(min·m2) vs. 2.01±0.54 L/(min·m2), P < 0.05) after 24 hours' treatment. In the levosimendan group, the changes of pulmonary capillary wedge pressure (PCWP), pulmonary arterial mean pressure (PAMP), sequential vascular response (SVR), and left ventricular ejection fraction (LVEF) were more obvious compared with those in the dobutamine group with statistical differences (all P < 0.05) after 24 hours' treatment. The offline time and ICU stay in the levosimendan group reduced compared with those of the dobutamine group with statistical differences (47.3±10.4 h vs. 52.5±7.6 h, P < 0.05; 5.3±2.2 d vs. 6.8±3.5 d, P < 0.05). There was no statistical difference in the incidence of adverse events between the two groups (P > 0.05). ConclusionCompared with dobutamine, levosimendan can improve hemodynamic stability of patients with severe valvular disease in perioperative period with good tolerability and safety.
ObjectiveTo explore the reason of failure in noninvasive positive pressure ventilation (NPPV) for treatment of postoperative hypoxemia, in order to better guide use of NPPV after cardiac surgery. MethodsWe retrospectively analyzed the clinical data of 64 patients after heart surgery with undergoing NPPV treatment due to hypoxemia in our hospital between January 2012 and December 2013 year.There were 49 males and 15 females at age of 28 to 87 years. There were 17 patients with NPPV failure. The related factors for failure of NPPV were analyzed. ResultsFactors associated with failure of NPPV included smoking history, preoperative pulmonary function abnormalities, blood transfusion amount > 1 000 ml, simplified acute physiology score Ⅱ(SAPS Ⅱ) before NPPV > 35 points, oxygenation index (PaO2/FiO2) < 100 mm Hg before NPPV, PaO2/FiO2 < 150 mm Hg after NPPV treatment for 1 h, mechanical ventilation time > 72 h at the first time, and pneumonia (P < 0.05). The SAPS Ⅱ > 35 points before NPPV and pneumonia were the independent risk factors for NPPV treatment failure for postoperative hypoxemia. ConclusionPostoperative NPPV for heart disease should be according to the cause of low oxygen and severity. For patients with SAPS less than 35 points before NPPV or patients with pneumonia, NPPV should not be used. In the process of NPPV, if clinical effect is not satisfied, it should be converted to invasive ventilation immediately.
ObjectiveTo investigate the clinical efficacy and safety of carvedilol in the treatment of arrhythmia in patients with hypertension complicated with diabetes mellitus. MethodsWe selected the patients with hypertension complicated with diabetes mellitus who were hospitalized in the Harrison International Peace Hospital Affiliated to Hebei Medical University for treatment from Oct. 2011 to Oct. 2013. The cases were divided into a trial group and a control group. The control group was given routine treatment (eg., hypoglycaemic drugs, angiotensin converting enzyme inhibitors). On the basis of the same treatment of the control group, the trial group was given carvedilol. The efficacy and adverse reaction were observed, recorded and then analyzed between the two groups. ResultsA total of 140 patients were included (70 cases in each group). With the loss of 10 cases in the control group, the data of 70 cases in the trial group and 60 cases in the control group were finally analyzed. The results showed that the trial group was superior to the control group in the total effectiveness (χ2=8.320, P=0.004) and the dynamic ECG improvement of premature ventricular contraction (χ2=5.333, P=0.014) with significant differences. Both groups were significantly improved in blood pressure and heart beats compared with the situation before treatment (Both P < 0.05), and the trial group was better than the control group with a significant difference. During the treatment, three cases in the trial group had mild gastrointestinal symptoms which spontaneously disappeared later. ConclusionThe clinical effectiveness of carvedilol for arrhythmia in patients with hypertension complicated with diabetes mellitus is significant. It is safe and effective which is recommended in clinical application.
ObjectiveTo systematically review the diagnostic value between serum human epididymis protein 4 (HE4) and carbohydrate antigen 125 (CA125) for endometrial cancer (EC). MethodsWe electronically searched databases including PubMed, The Cochrane Library, Web of Science, ScienceDirect, EBSCO, CNKI and VIP to collect diagnostic accuracy studies of serum HE4 and/or CA125 versus golden standard (pathology) for EC from inception to August 2014. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies by QUADAS-2 tool. Then, meta-analysis was performed by Meta-Disc 1.4 software. ResultsA total of 20 studies involving 4 351 participants were included. The results of meta-analysis showed that:the pooled sensitivity (Sen), specificity (Spe), positive likelihood ratio (+LR), and negative likelihood ratio (-LR), and diagnostic odds ratio (DOR) of HE4 in the diagnosis of EC were 0.56 (95%CI 0.54 to 0.58), 0.89 (95%CI 0.88 to 0.90), 6.19 (95%CI 4.31 to 8.88), 0.49 (95%CI 0.44 to 0.56), and 14.27 (95%CI 9.50 to 21.42), respectively. The area under the curve (AUC) of SROC was 0.855 9. The pooled Sen, Spe, +LR,-LR, and DOR of CA125 in the diagnosis of EC were 0.33 (95%CI 0.31 to 0.34), 0.80 (95%CI 0.78 to 0.82), 2.07 (95%CI 1.45 to 2.95), 0.83 (95%CI 0.76 to 0.91), and 2.65 (95%CI 1.63 to 4.32), respectively. The SROC AUC was 0.657 5. ConclusionCompared with CA125, HE4 has higher diagnostic accuracy for EC. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo explore the effect of full nutritional management pattern on perioperative nutritional status in patients with head and neck malignancies. MethodsSixty-four patients with head and neck cancer treated in our department between March 2012 and June 2013 were randomly divided into control group and study group with 32 in each. The control group received conventional dietary guidance, while patients in the study group were given full nutritional management. Nutritional Risk Screening Scale 2002 (NRS-2002) was used for nutrition screening and assessment before surgery (after admission) and after surgery (3 days after surgery). The study group received full nutritional support, along with nutrition-related physical examination and biochemical tests, and observation of postoperative complications, and hospital stay and costs were also observed. ResultsNutritional risk existed in 29.7%-48.4% of the head and neck cancer patients during various stages of the perioperative period. Through the full nutritional support, patients in the study group had a significantly lower risk than those in the control group (P<0.01). Body mass index, triceps skinfold thickness, mid-arm muscle circumference, prealbumin, and creatinine in the study group were significantly more improved compared with the control group (P<0.01). No significant difference was detected in blood urea and serum albumin between the two groups. Postoperative complications in the study group was significantly lower (P<0.05), and hospital stay and costs were significantly lower than the control group (P<0.001). ConclusionFull nutritional management pattern can significantly improve the perioperative nutritional status in head and neck cancer patients. Early detection of nutritional risk and malnutrition (foot) in the patients and carrying out normal and scientific nutrition intervention are helpful in the rehabilitation of these patients. We suggest that qualified hospitals should carry out the full nutritional management model managed by a Nutrition Support Team for patients with malignancies.
ObjectiveTo analyze the effectiveness of a new type of decellularized allogeneic bone in the application of anterior cervical discectomy and fusion (ACDF). MethodsA retrospective analysis was made on the clinical data of 73 patients with single segmental cervical spondylosis treated with ACDF between January 2009 and December 2013. Of 73 cases, autologous iliac bone was used in 22 cases (group A), new decellularized allogeneic bone transplantation (Bio-Gene) in 22 cases (group B), and normal allogeneic bone (Xin Kang Chen) in 24 cases (group C). There was no significant difference in gender, age, type of cervical spondylosis, course of disease, and involved segment among 3 groups (P>0.05). The operation time, intraoperative blood loss, and complications were compared between groups; X-ray films and CT images were taken to observe the bone fusion, and Japanese Orthopaedic Association (JOA) score was used to assess the clinical efficacy. ResultsThe operation time and intraoperative blood loss of group A were significantly more than those of groups B and C (P<0.05), but no significant difference was found between groups B and C (P>0.05). Pain and numbness at donor site occurred in 12 cases, and poor healing in 1 case of group A; red swelling and exudate were observed in 1 case of group B and in 6 cases of group C; and there was significant difference in complications among 3 groups (χ2=18.82, P=0.00). All patients were followed up 6-54 months (mean, 30 months). The graft fusion rate was 100% in groups A and B, and was 95.8% in group C, showing no significant difference (χ2=2.04, P=0.36). The JOA score at 6 months after operation were significantly improved when compared with preoperative score in 3 groups (P<0.05), but no significant difference was found among the 3 groups at preoperation and 6 months after operation (P>0.05). The excellent and good rates of groups A, B, and C were 90.9%, 88.9%, and 87.5% respectively, showing no significant difference (χ2=0.14, P=0.93). ConclusionNew type of decellularized allogeneic bone in ACDF has the advantages of shorter operation time, less blood loss, and better early effectiveness. But whether there is a chronic rejection or delayed rejection needs further studies.
Objective To review the research background, biomechanical characteristics, and clinical application of fenestrated pedicle screw (FPS). Methods The recent literature about the study and application of FPS was reviewed, analyzed, and summarized. Results Compared with the technique of conventional pedicle screw augmentation, FPS can be augmented with polymethyl methacrylate (PMMA) through inner central pore and side holes. Hence, the augmentation process of FPS is more convenient during operation. The biomechanics of PMMA augmented FPS is strong enough for instrumentation in osteoporotic vertebra body and the way of FPS PMMA augmentation can reduce the risk of PMMA leakage. Conclusion FPS is an innovation in the technology of spinal instrumentation, which is expected to improve the clinical outcome of PMMA augmented pedicle screw in osteoporotic vertebra body fixation.
ObjectiveTo summarize the experience of intra-aortic balloon pump (IABP) application on coronary artery bypass grafting（CABG）during perioperative period. MethodsWe retrospectively analyzed the data of 82 patients undergoing simple CABG operation in Wuhan Asia Heart Hospital between January 2011 and December 2013. There were 50 male and 32 female patients at age of 49-75 (63.6±11.5) years. The patients were divided into three groups including a group A (12 patients, preoperative-placed IABP), a group B(39 patients , postoperative active placed IABP), and a group C (31 patients, postoperative passive placed IABP). The clinical effects of the three groups were compared. ResultsThere were significantly statistic differences in sequential organ failure assessment (SOFA) score after postoperative 48 hours, ventilator supporting time, IABP supporting time, catecholamine drug usage time, infection incidence, incidence of ventricular arrhythmia, ICU retention time, postoperative hospital stay, CBP usage rate, and postoperative mortality (P<0.05) among the three groups with worse effect in the group C. ConclusionTaking IABP support during CABG perioperative period is an effective treatment. Preventively preoperative and actively postoperative placing IABP can improve the treatment effects significantly. Therefore, patients should apply CABG as soon as possible without hesitation when IABP indications occur.