老年高血压患者实施社区治疗及管理的效果

研究社区老年高血压患者采取社区治疗模式的效果。方法 选取于2018年10月~2019年10月社区中的老年高血压患者,共计80例。采取数字表法分为观察组(40例)和对照组(40例)。对照组患者常规治疗,观察组在常规模式基础上实施针对性的社区干预措施。比较两组患者的血压控制效果及并发症情况。结果 治疗和干预后,观察组患者的血压控制情况优对照组,并发症发生率低于对照组,两组数据存在较大差异,差异有统计学意义(P<0.05)。结论 本次研究表明,对社区老年高血压患者进行社区干预,对患者血压的控制及生活质量改善有着积极作用。

PDCA循环护理对血液透析动静脉内瘘保护效果的运用分析

血液透析病患采取PDCA循环护理后的动静脉瘘保护效果。方法 择取本院自2021年1月至2022年1月到院诊治的110例动静脉内瘘透析病患当作研究主体,随机均等的将其分成55例的对照组和55例的研究组,对照组施用的为常规性护理,研究组施用的为PDCA循环护理,比较两组病患并发症发生率、ESCA自护能力评分、护理满意度。结果 研究组各项指标均优于对照组(P﹤0.05)。结论 针对血液透析病患采取PDCA循环护理能减少并发症,提高其ESCA自护能力,能达到良好的动静脉内瘘保护效果。

EUS-guided drainage is more successful in pancreatic pseudocysts compared with abscesses

AIM: To compare the results for endoscopic ultrasound (EUS)-guided drainage of clear fluid pancreatic pseudocysts with the results for abscess drainage. METHODS: All patients referred for endoscopic drainage of a fluid collection were prospectively included. The outcome was recorded. RESULTS: Altogether 26 pseudocysts or abscesses were treated in 25 (6 female) patients. One endoscopist performed the procedures. Non-infected pseudocysts were present in 15 patients and 10 patients had infected fluid collections. The cyst size ranged between 28 cm × 13 cm and 5 cm × 5 cm. The EUS drainage was successful in 94% of the pseudocysts and in 80% of the abscesses (P = 0.04). The complication rate in pseudocysts was 6% and in abscesses was 30% (P = 0.02). Recurrence of a pseudocyst occurred in one patient (4%) after 6 mo; the patient was successfully retreated. CONCLUSION: EUS-guided drainage of pseudocysts is associated with a higher success rate and a lower complication rate compared with abscess drainage.

Appendiceal mass:Is interval appendicectomy “something of the past” ?

The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned.Furthermore,emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis.There is an increasing volume of evidence-although mostly retrospective-that if traditional conservative management is adopted,there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms.On the other hand,the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate.It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology.Moreover,it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration.If emergency LA is to become the standard of care for appendiceal mass,I.A will certainly become 'something' of the past.

Endoscopic submucosal dissection of a rectal carcinoid tumor using grasping type scissors forceps

Endoscopic submucosal dissection （ESD） with a knife is a technically demanding procedure a ssociated with ahigh complication rate. The shortcomings of this meth-od are the inability to fix the knife to the target lesion,and compression of the lesion. These can lead to major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps （GSF）,which can grasp and incise the targeted tissue using electrosurgical current. Colonoscopy on a 55-year-old woman revealed a 10-ram rectal submucosal nodule.The histological diagnosis of the specimen obtained by biopsy was carcinoid tumor. Endoscopic ultrasonog-raphy demonstrated a hypoechoic solid tumor limitedto the submucosa without lymph node involvement. Itwas safely and accurately resected without unexpectedincision by ESD using a GSF. No delayed hemorrhage or perforation occurred. Histological examination confirmed the carcinoid tumor was completely excisedwith negative resection margin.

Prognostic factors for 5-year survival after local excision of rectal cancer

AIM:To evaluate the prognostic factors for 5-year survival after local excision of rectal cancer,and to examine the therapeutic efficacy and surgical indications for this procedure. METHODS:Clinical data,obtained from 106 local rectal cancer excisions performed between January 1980 and December 2005,were retrospectively analyzed.Survival analysis was performed using the Kaplan-Meier method,statistical comparisons were performed using the log-rank test,and multivariate analysis was performed using the Cox proportional hazards model. RESULTS:Transanal,transsacral,and transvaginal excisions were performed in 92,12,and 2 cases, respectively.The rate of complication,local recurrence, and 5-year survival was 6.6%,17.0%,and 86.7%, respectively.Univariate analysis showed that T stage, vascular invasion,and local recurrence were related to the prognosis of the cases(P<0.05).Multivariate analysis showed that T stage[P=0.011,95% confidence interval(CI)=1.194-3.878]and local recurrence(P=0.022,95%CI=1.194-10.160)were the major prognostic factors for 5-year survival of cases after local excision of rectal cancer. CONCLUSION:Local rectal cancer excision is associated with few complications,and suitable for stages Tis and T1 rectal cancer.Prevention of local recurrence,active postoperative follow-up,and administration of salvage therapy are the effective methods to increase the efficacy of local excision of rectal cancer.

Advances in the diagnosis and treatment of patients with cancer cachexia

Cachexia is a common complication with an incidence rate of 50%–80% in cancer patients. It is also responsible for 20% of mortality among these patients. Cachexia can significantly reduce the efficacy of antitumor therapies and increase treatment-related toxicity and adverse effects in cancer patients. This increases the symptom burden in patients, affects their quality of life, and ultimately shortens their survival time. The mechanism underlying the development of cachexia is complex and diverse and involves various factors and pathways, each playing an important role. Treatment approaches for cachexia are multimodal, including nutrition support therapy, appetite stimulants, and therapeutic drugs that specifically target the mechanism behind the disease. In recent years, we have gradually gained a better understanding of cachexia, and significant progress has been made in delineating molecular mechanisms, staging and diagnosis, and therapeutic drug treatment of cancer cachexia. This article reviews the research progress of cancer cachexia based on these contexts.

Impact of medical therapies on inflammatory bowel disease complication rate

Crohn's disease and ulcerative colitis are progressive diseases associated with a high risk of complications over time including strictures,fistulae,perianal complications,surgery,and colorectal cancer.Changing the natural history and avoiding evolution to a disabling disease should be the main goal of treatment.In recent studies,mucosal healing has been associated with longer-term remission and fewer complications.Conventional therapies with immunosuppressive drugs are able to induce mucosal healing in a minority of cases but their impact on disease progression appears modest.Higher rates of mucosal healing can be achieved with anti-tumor necrosis factor therapies that reduce the risk of relapse,surgery and hospitalization,and are associated with perianal fistulae closure.These drugs might be able to change the natural history of the disease mainly when introduced early in the course of the disease.Treatment strategy in inflammatory bowel diseases should thus be tailored according to the risk that each patient could develop disabling disease.

Compare the postoperative complications incidence of benign multi-nodular goiter: A meta-analysis

Objective： The aim of our study was to compare the risk of main postoperative complications of patients un- derwent total thyroidectomy （TT）, near total thyroidectomy （NTT） and subtotal thyroidectomy （ST） for treating BMNG. Methods： Electronic databases including Cochrane Controlled Trials Register, EMbase, Medline, SCI Expanded-ISI, NTIS, SIGLE and CNKI were searched. Eligible studies were randomized controlled trials which compared the incidence of postoperative complications of TT with ST/NTT for treating BMNG. Data extraction was using predefined data fields and assessment of methodological quality with the GRADE approach. A ManteI-Haenszel random-effects model was used and the effect sizes were expressed by using relative risks and 95% confidence intervals. Results： Four studies including 881 participants that met inclusion criteria were analyzed. Compared with ST/NTT, TT was associated with increased risk of transient RLNI （recur- rent laryngeal nerve injuries） （relative risk 2.18, 95% confidence interval 1.08 to 4.42; P 〈 0.05） and transient hypocalcemia （3.79, 1.64 to 8.77; P 〈 0.05）, but there were no statistically significant differences in permanent RLNI （1.36, 0.31 to 6.02; P 〉 0.05） and permanent hypocalcemia （2.37, 0.35 to 15.97; P 〉 0.05）. The quality of evidence for each individual outcome was ultimately rated as moderate （permanent RLNI and permanent hypocalcemia）, low （transient RLNI and transient hypocalce- mia）. Conclusion： For treating BMNG with thyroidectomy, there were no statistically significant differences in postoperative complications between TT and ST/NTT on a long view.

Implementing a model for identifying organizational complications for the purpose of increasing productivity in hydropower plant

The present economical conditions on today＇s world require specific point of view and policy making in business agencies. In this competitive world to achieve competence, competitive advantages in order to better governance, organizations have to increase their competitive powers through promotion and productivity. One of the fundamental approaches to elevate the productivity level is finding the complications and obstacles, and arise planning to remove them. In order to understand organizational complication, we have tried to take critical factors of success and continue improvement into consideration to demonstrate a model to find the main and radical problems and complications and recognize the recoverable areas in the business agencies. In order to verify and validate the performed research, he planned model has been accomplished in the Hydropower Plant Department, positive and acceptable results were obtained and organizations total factor productivity improvement was achieved which was appreciated by the organization.

Median sternotomy closure:review and update research

Cardiac surgery is a very common operation nowadays all over the world.Median sternotomy is a routine procedure required for cardiac access during open heart surgery.The complications of this procedure after the cardiac surgery range from 0.7% to 1.5% of all cases,and bear a high mortality rate if they occur.Every individual surgeon must pay great attention on every detail during the sternal closure.This article shows the details as to conventional information and updated progress on median sternotomy closure.The update contents involve in biomechanics,number of wires twists,biomaterial and so on.According to our experience,we recommend four peristernal single/double steel wires for sternal closure as our optimal choice.

A two-choice strategy through a medial tibial approach for the treatment of pilon fractures with posterior or anterior fragmentation

Objective： The anterolateral approach to the tibia has been popularized for the management of tibial pilon fractures. For complex fracture patterns a com- bined anterolateral/anteromedial approach is suitable but a high rate of complication has been reported. In our retro- spective study a two-choice strategy adopting a medial tibial approach was proposed for the treatment of pilon fractures with anterior or posterior fragmentation. Methods： Based on an anatomic study oftibial pilon fractures, we retrospectively analyzed the fractures with primary posterior, posterior-lateral or anterior, anterior-lat- eral （Tillaux-Chaput） involvement of the distal tibia. This retrospective study consisted of 18 patients with a closed tibial plafond fracture. The inclusion criteria were： （1） pre- sence of an anterior/anterolateral type fragment or a poste- rior （Volkmann） type fragment involving 〉25% of the articu- lar surface, （2） a minimum follow-up of 12 months, （3） a fibula fracture associated with a medial colunm fracture of the distal tibia, and （4） soft tissue conditions at the time of opera- tion that did not compromise the choice of surgical access （Tscheme classification for closed fractures： grade 0 and grade 1）. Tibial plafond fractures were classified into two groups： one presenting anterior and the other with poste- rior rim （Volkmann） fragments. Results： Most patients achieved a good clinical re- covery in terms of range of motion and Olerud-Molander scale scores. Only three patients presented a grade 2 os- teoarthritis at the 12 month follow-up. Conclusion： Our two-choice strategy highlights con- cepts which have been previously debated and described in the literature. But a new extended protocol for surgical approach to the distal tibia, including more fracture pat- terns and their association should be further investigated.

Comparison of outcomes following three surgical techniques for patients with severe jejunoileal atresia

Background:Severe jejunoileal atresia is associated with prolonged parenteral nutrition,higher mortality and secondary surgery.However,the ideal surgical management of this condition remains controversial.This study aimed to compare the outcomes of patients with severe jejunoileal atresia treated by three different procedures.Methods:From January 2007 to December 2016,105 neonates with severe jejunoileal atresia were retrospectively reviewed.Of these,42 patients(40.0%)underwent the Bishop–Koop procedure(BK group),49(46.7%)underwent primary anastomosis(PA group)and 14(13.3%)underwent Mikulicz double-barreled ileostomy(DB group).Demographics,treatment and outcomes including mortality,morbidity and nutrition status were reviewed and were compared among the three groups.Results:The total mortality rate was 6.7%,showing no statistical difference among the three groups(P=0.164).The BK group had the lowest post-operative complication rate(33.3%vs 65.3%for the PA group and 71.4%for the DB group,P=0.003)and re-operation rate(4.8%vs 38.8%for the PA group and 14.3%for the DB group,P<0.001).Compared with the BK group,the PA group showed a positive correlation with the complication rate and re-operation rate,with an odds ratio of 4.15[95%confidence interval(CI):1.57,10.96]and 12.78(95%CI:2.58,63.29),respectively.The DB group showed a positive correlation with the complication rate when compared with the BK group,with an odds ratio of 7.73(95%CI:1.67,35.72).The weight-for-age Z-score at stoma closure was–1.22(95%CI:–1.91,–0.54)in the BK group and–2.84(95%CI:–4.28,–1.40)in the DB group(P=0.039).Conclusions:The Bishop–Koop procedure for severe jejunoileal atresia had a low complication rate and re-operation rate,and the nutrition status at stoma closure was superior to double-barreled enterostomy.The Bishop–Koop procedure seems to be an appropriate choice for severe jejunoileal atresia.

Use of tightrope fixation in ankle syndesmotic injuries

Objective： Conventional fixation of syndesmotic injuries with screws remains problematic. A novel fibrewire device （Tightrope） has suggested advantages. However, small case series have reported high soft tissue complication rates. The purpose of our study was to quantify complication rates and further procedures in patients treated with Tightropes. A secondary objective was to determine incidence of complications and further procedures in those treated with syndesmotic screws over the same period. Methods： All patients undergoing syndesmotic fixa- tion for ankle fracture between May 2008 and October 2009 were retrospectively reviewed. Incidence of complications, secondary procedures, maintenance of syndesmotic reduc- tion and time spent on non-weight bearing were recorded. Family doctors were contacted for those treated with Tight- ropes to check for any complications managed elsewhere. Results： Thirty-five patients required syndesmoticfixation, in which 12 were treated with Tightropes. They were followed up in clinic for a mean of 12.4 weeks. Family doctors were contacted at mean 14.6 months after treatment to determine any complications suffered. There were no complications attributable to method of fixation. In this series, 12 patients underwent 13 procedures and no patient had recurrent diastasis at discharge; 23 patients treated with screw fixation underwent 45 procedures （19 were screw removals）. There was 1 case ofsyndesmotic diastasis. Screw removal resulted in 2 minor complications. Conclusion： Tightrope fixation provideds effective syndesmotic fixation that is maintained at discharge. We do not experience soft tissue complications reported elsewhere.