AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality ...AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.展开更多
This study reviews the impacts of climate change on human health and presents corresponding adaptation strategies in South China. The daily mean surface air temperatures above or below 26.4~C increase the death risk f...This study reviews the impacts of climate change on human health and presents corresponding adaptation strategies in South China. The daily mean surface air temperatures above or below 26.4~C increase the death risk for people in Guangzhou, especially the elderly are vulnerable to variations in temperature. Heat waves can cause insomnia, fatigue, clinical exacerbation, or death from heatstroke etc., while cold spells show increases in patients with fractures. During a cold spell period, the rates of both on-site emergency rescues and non-implementable rescues increase, and the risk of non-accidental deaths and respiratory disease deaths significantly rise as well. Both time series of hazy days and ozone concentrations have significant positive correlations with the number of patients with cardiovascular diseases. Both malaria and dengue fever reach higher altitudes and mountainous areas due to climate warming. Climate change is likely to bring stronger heat waves in the future, thereby increasing heat wave-related illnesses and deaths, particularly in the metropolitan areas of the Pearl River Delta. The projected increase of consecutive cold days in Guangdong province and parts of northern Guangxi province will affect residents＇ health in the future. The rising temperature exaggerates ozone pollution, but it is not clear whether climate change is aggravating or mitigating haze pollution. The transmission potential of malaria in South China will increase by 39%-140% and the transmission season will extend by 1 2 months with an air temperature increase of 1-2~C. By 2050, most areas in Hainan province are projected to convert from non-endemic dengue into endemic dengue areas. The aging population will cause more vulnerable people. To mitigate the adverse impacts of climate change on human health, sound and scientific adaptation strategies must be adopted in advance, such as strengthening the surveillance of epidemic diseases in potential transmission areas, conducting timely weather forecasting for human health, evaluating health vulnerability to climate change, improving environmental and health education, and strengthening hazard management and the cooperation between meteorological and health departments.展开更多
NOWADAYS,Fontan circulation always refers to the hemodynamic status after total cavo-pul-monary connection, which was first created in the 1990s. There are two modern surgeryforms, one creating a channel within the r...NOWADAYS,Fontan circulation always refers to the hemodynamic status after total cavo-pul-monary connection, which was first created in the 1990s. There are two modern surgeryforms, one creating a channel within the right atrium and another making an extra-cardiac channel to connect infe-rior venous cava directly to the right pulmonary artery. Parturients with Fontan circulation are at increased risk of cardiac morbidity and thrombotic complications. We pre-sented a parturient with reduced platelet status of un-known reason undergoing an emergent cesarean delivery.展开更多
The treatment of extensive severe burn injury is very difficult, especially when some complications are involved. A burned patient sustained 98% total body surface area (TBSA) with 95% full thickness burn and severe i...The treatment of extensive severe burn injury is very difficult, especially when some complications are involved. A burned patient sustained 98% total body surface area (TBSA) with 95% full thickness burn and severe inhalation injury was admitted to our hospital in 08- 2000. After aggressive treatment, the patient recovered fully. This paper reports the treatment of the patient.展开更多
Thoracic impalement injuries are very rare and the majority of patients do not survive to reach a medical care facility.In this case report,we describe the successful outcome of a case of double thoracic impalement by...Thoracic impalement injuries are very rare and the majority of patients do not survive to reach a medical care facility.In this case report,we describe the successful outcome of a case of double thoracic impalement by two steed tors,of which one steel tor had impaled two patients simultaneously.The case report highlights all aspects of managing such rare and complex cases right from prehospital care; extrication process which happened under controlled environment at the trauma centre itself,till the definitive management of the impaled thoracic objects.Thoracic impalement injuries are dramatic and appear very challenging.However presence of mind of the managing team,coordinated team effort and availability of adequate facilities can lead to a successful outcome.展开更多
文摘AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.
基金supported by the Special Climate Change Research Program of China Meteorological Ad-ministration(No.CCSF-09-11 and CCSF201307)by the Science and Technology Planning Project of Guang-dong province(No.2011A030200021)
文摘This study reviews the impacts of climate change on human health and presents corresponding adaptation strategies in South China. The daily mean surface air temperatures above or below 26.4~C increase the death risk for people in Guangzhou, especially the elderly are vulnerable to variations in temperature. Heat waves can cause insomnia, fatigue, clinical exacerbation, or death from heatstroke etc., while cold spells show increases in patients with fractures. During a cold spell period, the rates of both on-site emergency rescues and non-implementable rescues increase, and the risk of non-accidental deaths and respiratory disease deaths significantly rise as well. Both time series of hazy days and ozone concentrations have significant positive correlations with the number of patients with cardiovascular diseases. Both malaria and dengue fever reach higher altitudes and mountainous areas due to climate warming. Climate change is likely to bring stronger heat waves in the future, thereby increasing heat wave-related illnesses and deaths, particularly in the metropolitan areas of the Pearl River Delta. The projected increase of consecutive cold days in Guangdong province and parts of northern Guangxi province will affect residents＇ health in the future. The rising temperature exaggerates ozone pollution, but it is not clear whether climate change is aggravating or mitigating haze pollution. The transmission potential of malaria in South China will increase by 39%-140% and the transmission season will extend by 1 2 months with an air temperature increase of 1-2~C. By 2050, most areas in Hainan province are projected to convert from non-endemic dengue into endemic dengue areas. The aging population will cause more vulnerable people. To mitigate the adverse impacts of climate change on human health, sound and scientific adaptation strategies must be adopted in advance, such as strengthening the surveillance of epidemic diseases in potential transmission areas, conducting timely weather forecasting for human health, evaluating health vulnerability to climate change, improving environmental and health education, and strengthening hazard management and the cooperation between meteorological and health departments.
文摘NOWADAYS,Fontan circulation always refers to the hemodynamic status after total cavo-pul-monary connection, which was first created in the 1990s. There are two modern surgeryforms, one creating a channel within the right atrium and another making an extra-cardiac channel to connect infe-rior venous cava directly to the right pulmonary artery. Parturients with Fontan circulation are at increased risk of cardiac morbidity and thrombotic complications. We pre-sented a parturient with reduced platelet status of un-known reason undergoing an emergent cesarean delivery.
文摘The treatment of extensive severe burn injury is very difficult, especially when some complications are involved. A burned patient sustained 98% total body surface area (TBSA) with 95% full thickness burn and severe inhalation injury was admitted to our hospital in 08- 2000. After aggressive treatment, the patient recovered fully. This paper reports the treatment of the patient.
文摘Thoracic impalement injuries are very rare and the majority of patients do not survive to reach a medical care facility.In this case report,we describe the successful outcome of a case of double thoracic impalement by two steed tors,of which one steel tor had impaled two patients simultaneously.The case report highlights all aspects of managing such rare and complex cases right from prehospital care; extrication process which happened under controlled environment at the trauma centre itself,till the definitive management of the impaled thoracic objects.Thoracic impalement injuries are dramatic and appear very challenging.However presence of mind of the managing team,coordinated team effort and availability of adequate facilities can lead to a successful outcome.
