Analysis of the relationship between deep venous catheter-related infection and post-operative complications in patients receiving minimally invasive esophagectomy

Objective The aim of the study was to evaluate catheter-related infection rate(CRIR)for patients receiving minimally invasive esophagectomy(MIE),to identify the optimal catheterization approach and relationship between CRIR and post-operative complications.Methods In total,168 patients with esophageal carcinoma and undergoing MIE combined with preoperative deep venous catheterization(DVC)were analyzed in our institution(Qingdao Municipal Hospital,China),from 2014 to 2018.After completing DVC,catheter-tips together with intraductal venous blood samples were sent to the microbiology lab for bacterial strain culture.CRIR was statistically evaluated for the following clinical variables:gender,age,smoking status,drinking status,past history,tumor location,histologic grade,pathological T,N,and M category,anastomotic location,anastomotic leakage,anastomotic stricture,chylothorax,pneumonia,recurrent laryngeal nerve(RLN)injury,reflux esophagitis,catheterization site,and catheter-locking days.Results Among the 144 patients recruited in our study,105 catheters were inserted into the jugular vein and 39 catheters into the subclavian vein.The median age of these patients was 63 years(range:42–79 years),and the median catheter-locking period was seven days(range:4–21 days).Four catheters were identified with three types of strain colonizations,including Staphylococcus epidermidis,Staphylococcus aureus and Blastomyces albicans.Statistical data showed that patients diagnosed with catheter-related infection were likely to incur anastomotic leakage(66.67%,P<0.001)and pneumonia(27.27%,P<0.001);features such as tumors located in the upper esophagus(13.6%,P=0.003),and over seven catheterlocking days(10.00%,P<0.001)were attributed to a high CRIR.Conclusion Although both jugular and subclavian veins can be catheterized for patients with MIE,DVC is associated with more than seven catheter-locking days and upper esophagectomy,due to high CRIR.Furthermore,catheter-related infection is related to anastomotic leakage and pneumonia.

After cochlear implantation: Complications related to flap around implants

Objective: To report complications related to flap around implants after cochlear implantation, possible causes of such complications and treatments. Methods and material:We performed a retrospective analysis of children in whom complications related to flap around implants occurred after undergoing cochlear implantation in our department from 2005 to 2016. Results:Complications among 1500 cochlear implantation (CI) recipients by the same surgeon included hematoma (n ? 20) and seroma around implants (n ? 15), of which most (n ? 10) recovered in 2 weeks after effective drainage, utility of antibiotics and pressure dressing, but 5 developed flap necrosis and had to undergo contralateral re-implantation. Four patients developed abscess around implants, of whom 2 recovered after 2 weeks of drainage, gentamicin irrigation and use of antibiotics, but 2 patients ended up with flap necrosis and had to receive contralateral reimplantation. Conclusions: Immediate drainage, pressure dressing and antibiotics can be used to effectively control seroma around implants. For seroma lasting for more than two weeks without improvement, surgical drainage may be need.

Does parity worsen diabetes-related chronic complications in women with type 1 diabetes?

AIM: To determine the relationship between parity, glycemic control, cardiovascular risk factors and diabetesrelated chronic complications in women with type 1 diabetes.METHODS: This was a multicenter cross-sectional study conducted between December 2008 and December 2010 in 28 public clinics in 20 cities from the 4 Brazilian geographic regions. Data were obtained from 1532 female patients, 59.2% Caucasians, and aged 25.2 ± 10.6 years. Diabetes duration was of 11.5 ± 8.2 years. Patient's information was obtained through a questionnaire and a chart review. Parity was stratified in five groups: Group 0(nulliparous), group 1(1 pregnancy), group 2(2 pregnancies), group 3(3 pregnancies), group 4(≥ 4 pregnancies). Test for trend and multivariate random intercept logistic and linear regression models were used to evaluate the effect of parity upon glycemic control, cardiovascular risk factors and diabetes-related complications. RESULTS: Parity was not related with glycemic control and nephropathy. Moreover, the effect of parity upon hypertension, retinopathy and macrovascular disease did not persist after adjustments for demographic and clinical variables in multivariate analysis. For retinopathy, the duration of diabetes and hypertension were the most important independent variables and for macrovascular disease, these variables were age and hypertension. Overweight or obesity was noted in a total of 538 patients(35.1%). A linear association was found between the frequency of overweight or obesity and parity(P = 0.004). Using a random intercept multivariate linear regression model with body mass index(BMI) as dependent variable a borderline effect for parity(P = 0.06) was noted after adjustment for clinical and demographic data. The observed variability of BMI was not attributable to differences between centers.CONCLUSION: Our results suggest that parity has a borderline effect on body mass index but does not have an important effect upon hypertension and micro or macrovascular chronic complications. Future prospective evaluations must be conducted to clarify the relationship between parity, appearance or worsening of diabetesrelated chronic complications.

A Case Report of Concurrent Acne-Related Occurrence Complications: Telangiectasia, Post-Inflammatory Erythema, Post-Inflammatory Hyperpigmentation, and Atrophic and Hypertrophic Scars

Prior to his initial diagnosis, a 21-year-old male had been experiencing facial acne for two years and had been treated by a doctor in private practice. The patient visited our department because the clinical manifestations of mandibular acne did not improve. At the time of initial examination, telangiectasia (TE), post-inflammatory erythema (PIE), post-inflammatory hyperpigmentation (PIH), atrophic scars (ASs), and a hypertrophic scar (HS) with induration were observed on the right neck. We diagnosed this as an acne vulgaris complication. HS lesions were topically treated by injecting triamcinolone acetonide, and the patient was prescribed 8.1 g/day of oral Saireito (Japanese herb). Adapalene benzoyl peroxide gel and topical tacrolimus hydrate ointment were used to treat PIE and TE. Both HSs and PIE improved;however, TE and AS did not improve. Currently, the patient is under observation. We consider this to be a very rare concurrent occurrence of diverse complications of acne vulgaris, and present the following case study.

Surgical chest complications after liver transplantation

Liver transplantation is a major abdominal operation and the intimate anatomic relation of the liver with the right hemidiaphragm predisposes the patient to various manifestations in the chest cavity.Furthermore,chronic liver disease affects pulmonary function before and after liver transplantation resulting in a considerable percentage of patients presenting with morbidity related to chest complications.This review aims to identify the potential chest complications of surgical interest during or after liver transplantation.Complications of surgical interest are defined as those conditions that necessitate an invasive procedure(such as thoracocentesis or a chest tube placement)in the chest or a surgical intervention performed by a thoracic surgeon.These complications will be classified as perioperative and postoperative;the latter will be categorized as early and late.Although thoracocentesis or a chest tube placement is usually sufficient when invasive measures are deemed necessary,in some patients,thoracic surgical interventions are warranted.A high index of suspicion is needed to recognize and treat these conditions promptly.A close collaboration between abdominal surgeons,intensive care unit physicians and thoracic surgeons is of paramount importance.

Clinical Outcome of Children with Post Bacillus Calmette and Guerin Vaccination Complications: A Single Center Experience

Background: Bacillus Calmette ET Guerin (BCG) vaccine, compulsory in endemic areas, remains the only available vaccine for prevention of Tuberculosis (TB) despite its modest protective value. Complications may arise in healthy/ immunocompromized hosts. Methods: Children presenting with BCG vaccine related complications in the form of local/distant complications were enrolled from 2007-2010 at Cairo University Pediatric hospital. Objectives: assess outcome of BCG related complications in a group of children with post vaccination incidents, identify risk factors for complications among vaccinated children and identify cases of underlying Primary Immunodeficiency (PID) among presenting cases. Results: Fifty one eligible patients were included, forty three were proved immunocompetent, and eight had underlying primary immunodeficiency disorders. Presentations included localized axillary lymphadenopathy, cervical sinuses, granulomatous lesions and disseminated forms Faulty injection sites were strongly associated with complications (p value < 0.001).Patients without underlying PID had larger scar size and younger age at presentations (p values: 0.02, 0.0001 respectively).Resolution of lesions was observed in 97 % (95% CI 97% ± 3%) of cases without underlying PID versus fatal outcome in all cases with underlying immune defects. Conclusion: Local BCG related complications do not necessarily indicate underlying PID, disseminated complications are more serious and warrant further investigations. If PID is suspected, vaccination should be deferred to avoid its potentially fatal outcome.

Advances in the Study of Exosomal miRNAs in Diabetes and Its Complications

Diabetes mellitus is a group of metabolism-related diseases characterized by elevated plasma glucose levels, and the course of diabetes mellitus is closely linked to the development of diabetes-related complications, which can be life-threatening due to poor glycemic control. Exosomes are small vesicles that encapsulate intracellular molecules and are composed of a variety of bioactive proteins, lipids and nucleic acids (including microRNAs, lncRNAs, and circ-RNAs), and recent studies have increasingly shown that miRNAs in exosomes are an important mode of intercellular and intertissued communication and play a key role in the development and progression of various diseases. This review presents the progress of the application of exosomal miRNAs in type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and diabetes-related complications.

Expressions of TGF-β2, bFGF and ICAM-1 in lens epithelial cells of complicated cataract with silicone oil tamponade

AIM： To investigate the expression differences of transforming growth factor-β2（TGF-β2）, basic fibroblast growth factor（b FGF） and intercellular cell-adhesion molecule-1（ICAM-1） in lens epithelial cells（LECs） of complicated cataract with silicone oil tamponade and agerelated cataract. METHODS： Totally 150 eyes of 150 patients（aged 35 to 77y） were investigated, including 75 patients with complicated cataract after silicone oil tamponade and 75 patients with age-related cataract. The central piece of anterior capsules was collected during cataract surgery. TGF-β2, b FGF and ICAM-1 were detected in the 60 specimens of the two groups by immunohistochemistry. The expression levels of the three kinds of messenger ribonucleic acid（m RNA） were determined by real-time quantitative reverse transcriptionpolymerase chain reaction in the 90 specimens of the two groups.RESULTS： TGF-β2 was detected in the cytomembrane and cytoplasm of the LECs and b FGF was detected in the nucleus. ICAM-1 was positive in the cytomembrane of the LECs and the distribution of positive cells was uneven. The m RNA genes expression of the TGF-β2, b FGF and ICAM-1 was significant differences between the two groups and markedly increased in complicated cataract group（P〈0.05）.CONCLUSION： The up-regulated TGF-β2, b FGF and ICAM-1 maybe associate with the occurrence and development of complicated cataract with silicone oil tamponade.

Analysis of operation-related complications of totally laparoscopic aortoiliac surgery

Background Totally laparoscopic aortoiliac surgery has been newly developed in China.It is known as the most complex laparoscopic technique to learn because of its high-risk procedures.Analysis of the operation-related complications of this surgery is supposed to be helpful for the early success of this technique.Methods Twelve male patients （56-70 years old） with aortoiliac occlusive disease underwent totally laparoscopic aortoiliac bypass surgery （TLABS） in our institute.Clinical data and operation-related complications were retrospectively analyzed.Results Of the 12 patients,TLABS succeeded in nine and conversion to open surgery occurred in three.One of the converted patients finally died of pulmonary infection.Operation-related complications included bleeding from arterial injury,perforation from colonic injury,graft embolism,residual aortic stenosis,and hydronephrosis.Bleeding in two patients and colonic perforation in one patient resulted in three conversions to open surgery.Intraoperative graft embolectomy and postoperative aortic stenting were performed to resolve the thrombus/embolus-referring complications.Left hydronephrosis,which was thought to result from intraoperative injury and treated with ureteric intubation drainage,recovered 6 months after TLABS.Conclusions Good understanding and avoidance of operation-related complications are important to guarantee the technical success of TLABS.Immediate conversion to open surgery is necessary for saving the patient＇s life in case of lifethreatening complications.

腹腔镜直肠癌手术腹壁相关并发症的原因及预防措施

目的探讨腹腔镜直肠癌手术腹壁相关并发症出现的原因及预防措施。方法回顾性分析215例行腹腔镜直肠癌手术患者的临床资料,患者均在全身麻醉下采用传统5孔法行腹腔镜直肠癌前切除术(Dixon),根据手术切口作用及戳孔大小分为12 mm主操作孔(215孔)、12 mm观察孔(215孔)、5 mm辅助操作孔(645孔)。统计分析患者的腹壁并发症发生情况及处理情况;比较12 mm主操作孔与12 mm观察孔、12 mm观察孔与5 mm辅助操作孔的腹壁并发症发生情况。结果215例腹腔镜直肠癌Dixon手术出现腹壁相关并发症25孔。9孔发生感染,经通畅引流、换药好转出院。7孔发生出血,5孔经药物止血、局部压迫好转,2孔经缝扎止血等好转。5孔发生疝,其中3孔为大网膜疝,经回纳后缝合切口好转;2孔为小肠疝,经开腹手术治疗后痊愈。4孔发生皮下气肿,经保守治疗后好转。12 mm观察孔的感染及疝发生率分别为0.47%、0,明显低于12 mm主操作孔的3.72%、2.33%,差异具有统计学意义(P<0.05);而12 mm主操作孔与12 mm观察孔的出血及皮下气肿发生率比较差异均无统计学意义(P>0.05)。12 mm观察孔与5 mm辅助操作孔的感染、疝、出血及皮下气肿发生率比较差异均无统计学意义(P>0.05)。结论Trocar孔大小及是否关闭Trocar孔筋膜可能是切口感染及Trocar疝发生的重要影响因素;腹腔镜直肠癌手术腹壁相关并发症时有发生,临床医师需加强防范意识,减少腹壁相关并发症的发生。

2型糖尿病伴干眼症病人血清和泪液分泌型卷曲相关蛋白5、脂肪酸结合蛋白4水平与病情严重程度的相关性

目的分析分泌型卷曲相关蛋白5(SFRP-5)、脂肪酸结合蛋白4(FABP4)在2型糖尿病(T2DM)伴干眼症病人血清和泪液中的表达及其与病情严重程度的相关性。方法选取2020年12月至2021年12月唐山市眼科医院收治的T2DM病人145例,其中单纯T2DM病人84例168眼(T2DM组),伴干眼症病人61例122眼(T2DM伴干眼症组),另选取同期该院体检健康者50例100眼作为对照组。T2DM伴干眼症病人又分为轻度组(29例)、中度组(17例)、重度组(15例)。利用酶联免疫吸附法测定所有受试者血清和泪液中SFRP-5、FABP4水平;相关性分析采用Pearson法或Spearman法;logistic回归分析影响T2DM病人干眼症发生的因素。结果T2DM伴干眼症组、T2DM组血清和泪液SFRP-5水平均低于对照组(106.09±8.37、135.72±9.26比158.34±9.45,28.85±5.13、58.27±6.14比45.18±5.92),T2DM伴干眼症组低于T2DM组(P<0.05);T2DM伴干眼症组、T2DM组血清和泪液FABP4水平均高于对照组(70.63±6.59、58.27±6.14比45.18±5.92,15.91±3.76、10.28±3.58比7.72±3.29),T2DM伴干眼症组高于T2DM组(P<0.05)。重度组、中度组血清和泪液SFRP-5水平(68.29±7.15、95.54±8.34比131.82±9.02,12.83±4.62、24.72±5.49比39.56±5.18)、泪膜破裂时间(BUT)、泪液分泌试验(SIT)低于轻度组,重度组低于中度组(P<0.05);重度组、中度组血清和泪液FABP4水平(84.56±6.83、73.18±6.94比61.93±6.27,25.64±4.19、17.15±3.86比10.16±3.47)及眼表疾病指数量表(OSDI)积分高于轻度组,重度组高于中度组(P<0.05)。T2DM伴干眼症病人血清与泪液SFRP-5水平呈正相关,血清与泪液FABP4水平也呈正相关(P<0.05)。T2DM伴干眼症病人血清和泪液SFRP-5水平与OSDI积分均呈负相关,与BUT、SIT均呈正相关(P<0.05);血清和泪液FABP4水平与OSDI积分均呈正相关,与BUT、SIT均呈负相关(P<0.05)。血清和泪液SFRP-5水平是影响T2DM病人干眼症发生的独立保护因素,而血清和泪液FABP4水平是独立危险因素(P<0.05)。结论SFRP-5在T2DM伴干眼症病人血清和泪液中均低表达,FABP4均高表达,二者与病情严重程度密切相关。

急性压力性损伤风险防控护理在行肺癌根治术患者中的应用效果

目的探究急性压力性损伤风险防控护理在行肺癌根治术患者中的应用效果。方法选取2022年1月至2023年1月南京医科大学附属淮安第一医院120例行肺癌根治术患者作为研究对象,按照随机数字表法将其分为对照组和观察组,各60例。对照组采取常规手术护理措施,观察组应用术中急性压力性损伤风险防控护理。比较两组手术相关指标变化及并发症。结果术毕时,两组气道压、平均脉压、心率、体温、乳酸、血氧饱和度高于术前即刻,且观察组高于对照组,差异有统计学意义(P<0.05);观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论在行肺癌根治术患者中采用急性压力性损伤风险防控护理,可有效改善患者手术相关指标,降低并发症发生率,提高预后效果,值得临床推广采纳。

1型糖尿病患儿血清分泌型卷曲相关蛋白5水平与糖脂代谢和微血管并发症的关系

目的研究1型糖尿病患儿血清分泌型卷曲相关蛋白5(Secreted frizzled-related protein 5,SFRP5)的水平与糖脂代谢指标及和微血管并发症的关系。方法以2022年1月-2023年12月于山西省儿童医院就诊的96例1型糖尿病患儿为糖尿病组,选择同时期在本院接受健康体检的100名正常儿童作为健康组。分别测定两组血清SFRP5水平、空腹血糖(Fasting blood glucose,FBG)、总胆固醇(Total cholesterol,TC)、高密度脂蛋白胆固醇(High density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterin,LDL-C)、三酰甘油(Triacylglycerol,TG)水平以及糖化血红蛋白(Glycosylated hemoglobin,HbA1c),对糖尿病组患儿是否患有微血管并发症进行评估。采用Pearson相关性分析评估血清SFRP5水平与糖脂代谢指标间的相关性。采用受试者工作特征(Receiver operating characteristic,ROC)曲线评估血清SFRP5水平对1型糖尿病合并微血管并发症的诊断效能。结果与健康组比较,糖尿病组FBG、HbA1c、LDL-C和TG水平升高,HDL-C水平降低,差异有统计学意义(P<0.05)。糖尿病组血清SFRP5水平为(352.53±53.69)pg/mL,低于健康组[(424.49±63.54)pg/mL],差异有统计学意义(t=5.453,P<0.05)。糖尿病组血清SFRP5水平与FBG、HbA1c和TG水平呈负相关关系(P<0.05)。1型糖尿病合并微血管并发症儿童的HbA1c和LDL-C水平高于未合并微血管并发症儿童,差异有统计学意义(P<0.05)。与未合并微血管并发症患儿血清SFRP5水平[(363.43±57.24)pg/mL]比较,1型糖尿病合并微血管并发症患儿血清SFRP5水平(315.87±42.35)pg/mL降低,差异有统计学意义(t=4.042,P<0.001)。血清SFRP5水平对1型糖尿病合并微血管并发症诊断效能的曲线下面积为0.838(0.755~0.921),灵敏度为86.4%,特异度为73.0%。结论1型糖尿病患儿血清SFRP5水平低于健康儿童,血清SFRP5水平与血清FBG、HbA1c和TG含量呈负相关,合并微血管并发症的糖尿病患儿血清SFRP5水平低于未合并者。

PICC带管出院患者导管居家维护模式的可行性研究分析

目的 观察PICC带管出院患者导管居家维护模式的可行性。方法 将我院2021年1月至2022年12月收治的60例PICC带管肿瘤患者随机分为观察组30例,对照组30例。对照组(n=30)给予常规返院导管维护,观察组(n=30)给予导管居家维护,对比两组的单次维护费用及时间、平均留置时间、导管相关并发症发生情况及维护依存性。结果 观察组单次维护费用为(58.17±5.64)元,低于对照组的(132.78±9.85)元,两组单次维护费用比较,差异具有统计学意义(t=-36.004,P=0.000);观察组单次维护时间(81.13±7.62)min,较对照组的(203.34±15.67)min更短,差异具有统计学意义(t=-38.416,P=0.000)。观察组PICC平均留置时间为(141.82±13.56)d,对照组PICC平均留置时间为(137.43±14.08)d,两组PICC平均留置时间比较,差异未见统计学意义(t=1.230,P=0.224)。观察组导管相关并发症发生率36.67%,对照组26.67%,两组导管相关并发症比较,差异没有统计学意义﹙χ^(2)=0.693,P=0.405﹚。观察组能按时进行PICC导管维护者为28例,按时维护依存率为93.33%,高于对照组的70.00%,差异存在统计学意义﹙χ^(2)=5.455,P=0.020﹚。结论 PICC带管出院患者导管居家维护模式具有一定可行性,在不增加导管相关并发症及延长留置时间的前提下,可以有效地减少维护费用、缩短维护时间,提高患者维护依存性。

飞秒激光辅助下超声乳化术、普通白内障超声乳化术对年龄相关性白内障患者眼内压及最佳矫正视力、视盘区血流密度的影响

目的比较飞秒激光辅助下超声乳化术(FLACS)、普通白内障超声乳化术(CPCS)在年龄相关性白内障(ARC)患者中的效果。方法选取2021年7月至2023年7月南昌爱尔眼科医院收治的70例ARC患者作为研究对象,按随机数字表法分为对照组(35例)、观察组(35例)。对照组行CPCS,观察组行FLACS,两组术后均随访3个月。比较两组的手术相关指标、眼内压、黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)、视盘区血流密度、并发症等。结果观察组的超声乳化时间为(14.57±2.30)min,短于对照组的(22.49±3.58)min,观察组的超声乳化能量为(5.39±1.20)ml,低于对照组的(11.33±2.15)ml,观察组的并发症总发生率为5.71%(2/35),低于对照组的22.86%(8/35),差异有统计学意义(P<0.05)。重复测量方差分析结果显示,两组患者术前,术后1 d,术后1周,术后1、3个月BCVA的时间、组间比较,差异有统计学意义(P<0.05),交互作用比较,差异无统计学意义(P>0.05);两组患者术后1 d,术后1周,术后1、3个月的BCVA均高于本组术前,差异有统计学意义(P<0.05)。两组患者手术前后各时间点眼内压、CMT、视盘旁血流密度、视盘内血流密度的时间、组间、交互作用比较,差异无统计学意义(P>0.05)。结论FLACS具有更短的超声乳化时间,更少的乳化能量,其可提升视力,且不会加重对眼压、视盘区血流密度与CMT的影响,并发症较少。

PFNA-Ⅱ髓内钉治疗股骨转子间骨折对患者髋关节功能及血清炎症因子的影响

目的探讨PFNA-Ⅱ髓内钉治疗股骨转子间骨折对患者髋关节功能及血清炎症因子的影响。方法选择2020年1月-2022年12月丹阳市人民医院收治的股骨转子间骨折患者88例,以随机双盲方式分为对照组与观察组,各44例。对照组采用动力髋螺钉治疗,观察组采用PFNA-Ⅱ髓内钉治疗。对比两组围手术期相关指标、髋关节功能、血清炎症因子及术后并发症。结果观察组手术时长、切口长度、住院时间及骨折愈合时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。术后1个月、3个月、6个月,观察组Harris评分均高于对照组,血清TNF-α、IL-6及IL-1β水平均低于对照组,差异有统计学意义(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论采用PFNA-Ⅱ髓内钉治疗股骨转子间骨折患者可减轻其手术创伤,缩短其术后恢复时间,改善其髋关节功能,减轻其机体炎症反应。

术前造口定位对肠造口患者并发症发生率影响的Meta分析

目的评价术前造口定位对肠造口患者造口相关并发症的影响,为临床实践提供循证依据。方法检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Cochrane Library、CINAHL、Embase、Ovid Emcare、British Nursing Index,检索时限为建库至2022年6月15日。由2名研究者独立进行文献筛选、资料提取和质量评价,采用RevMan 5.3软件进行统计分析。结果共纳入32篇文献,Meta分析结果显示,术前造口定位可有效降低造口相关并发症总发生率[RR=0.38,95%CI(0.28,0.53),P<0.01]、造口周围皮肤并发症发生率[RR=0.47,95%CI(0.29,0.75),P<0.01]、造口渗漏发生率[RR=0.20,95%CI(0.09,0.45),P<0.01]、皮肤黏膜分离发生率[RR=0.28,95%CI(0.13,0.61),P<0.01]、造口回缩发生率[RR=0.50,95%CI(0.27,0.92),P=0.03]、造口狭窄发生率[RR=0.27,95%CI(0.10,0.72),P<0.01]、造口旁疝发生率[RR=0.23,95%CI(0.14,0.36),P<0.01]、造口脱垂发生率[RR=0.38,95%CI(0.19,0.76),P<0.01]及造口出血发生率[RR=0.26,95%CI(0.08,0.78),P=0.02],但不能显著降低造口缺血发生率[RR=0.45,95%CI(0.15,1.38),P=0.16]及造口水肿发生率。结论术前造口定位能有效降低肠造口患者造口相关并发症的总发生率,以及造口及造口周围皮肤并发症、造口旁疝、造口脱垂、造口出血的发生率,但对于降低造口缺血及造口水肿发生率的证据不足。

大黄及其类方应用于糖尿病的研究进展

近年来相关研究发现大黄及其类方对糖尿病的治疗有着广阔的前景,其通过对糖脂代谢的影响、血管活性因子的影响、相关细胞因子的调节等多个环节及多方面机制发挥其降糖、降脂、降低胰岛素水平、提高胰岛素敏感度、改善胰岛素抵抗、降低糖尿病并发症等功能。通过对临床及实验文献的整理和归纳从病因病机、临床用药、机理研究等方面对大黄及其类方治疗糖尿病及其并发症的研究进展进行了分析和研究,为大黄及其类方在临床上辨证治疗糖尿病,灵活精准用药奠定一定的理论研究基础。

耳穴揿针在癌症相关并发症治疗中的临床应用现状

由癌症及其治疗引起的相关并发症已经严重影响到了患者的治疗效果和生命质量。耳穴揿针疗法是由传统针刺疗法发展而来的新型耳针疗法,已在各种疾病的临床治疗中得到广泛应用,并体现出其独特的中医治疗优势。本文概述了耳穴揿针疗法治疗胃肠道不良反应、癌性疼痛、精神系统症状和癌因性疲乏等常见的癌症相关并发症的作用机制,介绍了各种癌症相关并发症的中西医治疗现状,以及病名、病因病机、中医治则和常用耳穴等中医认识,重点分析、总结了耳穴揿针在这些常见的癌症相关并发症的临床应用现状,发现耳穴揿针疗法在治疗癌症相关并发症上具有作用显著、安全性高、简单便捷和患者依从性高等优势。本文认为耳穴揿针疗法是一种能够改善癌症相关并发症,提高患者生命质量的有效措施,值得在癌症相关并发症的临床治疗中进一步推广。

妊娠相关急性肾损伤预后的研究进展

妊娠相关急性肾损伤(pregnancy-related acute kidney injury,PR-AKI)发病隐匿,病情进展迅速,是引起母婴不良结局和产科患者致命并发症的重要原因。孕期独特的生理环境给肾病科和产科医生的临床工作带来了极大的挑战。随着国家二胎政策的放开及辅助生殖技术的发展,高龄、高危产妇急剧增多,有必要提高对PR-AKI的认识。本篇综述重点介绍了PR-AKI预后的研究进展,为临床更好地了解PR-AKI母胎结局,确定哪些妇女有较高的不良预后风险,制定策略优化管理和治疗提供参考。