Hidden blood loss after intertrochanteric fractures in elderly patients and its influence on the postoperative function recovery:a random controlled trial

Objective To investigate hidden blood loss after various types of intertrochanteric fractures and to determine whether oral iron supplementations is benefical for the postoperative functional recovery in elderly patients.Methods From

Pre-hepatectomy type Ⅳ collagen 7S predicts post-hepatectomy liver failure and recovery

BACKGROUND Liver resection is an effective treatment for benign and malignant liver tumors.However,a method for preoperative evaluation of hepatic reserve has not yet been established.Previously reported assessments of preoperative hepatic reserve focused only on liver failure in the early postoperative period and did not consider the long-term recovery of hepatic reserve.When determining eligibility for hepatectomy,the underlying pathophysiology needs to be considered to determine if the functional hepatic reserve can withstand both surgery and any postoperative therapy.AIM To identify pre-hepatectomy factors associated with both early postoperative liver failure and long-term postoperative liver function recovery.METHODS This study was a retrospective cohort study.We retrospectively investigated 215 patients who underwent hepatectomy at our hospital between May 2013 and December 2016.Early post-hepatectomy liver failure(PHLF)was defined using the International Study Group of Liver Surgery’s definition of PHLF.Long-term postoperative recovery of liver function was defined as the time taken for serum total bilirubin and albumin levels to return to levels of<2 mg/dL and>2.8 g/dL,respectively,and the time taken for Child-Pugh score to return to Child-Pugh class A.RESULTS Preoperative type IV collagen 7S was identified as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function.Further analysis revealed that the time taken for the recovery of Child-Pugh scores and serum total bilirubin and albumin levels was significantly shorter in patients with type IV collagen 7S≤6 ng/mL than in those with type IV collagen 7S>6 ng/mL.In additional analyses,similar results were observed in patients without chronic viral hepatitis associated with fibrosis.CONCLUSION Preoperative type IV collagen 7S is a preoperative predictor of PHLF and longterm postoperative liver function recovery.It can also be used in patients without chronic hepatitis virus.

Effect of inferior vena cava respiratory variability-guided fluid therapy after laparoscopic hepatectomy:a randomized controlled clinical trial

Background:After major liver resection,the volume status of patients is still undetermined.However,few concerns have been raised about postoperative fluid management.We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection(LLR)with or without inferior vena cava(IVC)respiratory variability-directed fluid therapy in the anesthesia intensive care unit(AICU).Methods:This randomized controlled clinical trial enrolled 70 patients undergoing LLR.The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU,while the standard practice of fluid management was used for the control group.The primary outcome was the time to flatus after surgery.The secondary outcomes included other indicators of gut function recovery after surgery,postoperative length of hospital stay(LOS),liver and kidney function,the severity of oxidative stress,and the incidence of severe complications associated with hepatectomy.Results:Compared with patients receiving standard fluid management,patients in the intervention group had a shorter time to anal exhaust after surgery(1.5±0.6 days vs.2.0±0.8 days)and lower C-reactive protein activity(21.4[95%confidence interval(CI):11.9-36.7]mg/L vs.44.8[95%CI:26.9-63.1]mg/L)24 h after surgery.There were no significant differences in the time to defecation,serum concentrations of D-lactic acid,malondialdehyde,renal function,and frequency of severe postoperative complications as well as the LOS between the groups.Conclusion:Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR.Trial Registration:ChiCTR-INR-17013093.