Present and future of new systemic therapies for early and intermediate stages of hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is a high mortality neoplasm which usually appears on a cirrhotic liver.The therapeutic arsenal and subsequent prognostic outlook are intrinsically linked to the HCC stage at diagnosis.Notwithstanding the current deployment of treatments with curative intent(liver resection/local ablation and liver transplantation)in early and intermediate stages,a high rate of HCC recurrence persists,underscoring a pivotal clinical challenge.Emergent systemic therapies(ST),particularly immunotherapy,have demonstrate promising outcomes in terms of increase overall survival,but they are currently bound to the advanced stage of HCC.This review provides a comprehensive analysis of the literature,encompassing studies up to March 10,2024,evaluating the impact of novel ST in the early and intermediate HCC stages,specially focusing on the findings of neoadjuvant and adjuvant regimens,aimed at increasing significantly overall survival and recurrence-free survival after a treatment with curative intent.We also investigate the potential role of ST in enhancing the downstaging rate for the intermediate-stage HCC initially deemed ineligible for treatment with curative intent.Finally,we critically discuss about the current relevance of the results of these studies and the encouraging future implications of ST in the treatment schedules of early and intermediate HCC stages.

Aluminum phosphate gel reduces early rebleeding in cirrhotic patients with gastric variceal bleeding treated with histoacryl injection therapy

BACKGROUND Esophageal-gastro varices bleeding(EGVB)is the most widely known cause of mortality in individuals with cirrhosis,with an occurrence rate of 5%to 15%.Among them,gastric varices bleeding(GVB)is less frequent than esophageal varices bleeding(EVB),but the former is a more critical illness and has a higher mortality rate.At present,endoscopic variceal histoacryl injection therapy(EVHT)is safe and effective,and it has been recommended by relevant guidelines as the primary method for the treatment of GVB.However,gastric varices after endoscopic treatment still have a high rate of early rebleeding,which is mainly related to complications of its treatment,such as bleeding from drained ulcers,rebleeding of varices etc.Therefore,preventing early postoperative rebleeding is very important to improve the quality of patient survival and outcomes.AIM To assess the efficacy of aluminium phosphate gel(APG)combined with proton pump inhibitor(PPI)in preventing early rebleeding after EVHT in individuals with GVB.METHODS Medical history of 196 individuals with GVB was obtained who were diagnosed using endoscopy and treated with EVHT in Shenzhen People's Hospital from January 2016 to December 2021.Based on the selection criteria,101 patients were sorted into the PPI alone treatment group,and 95 patients were sorted into the PPI combined with the APG treatment group.The incidences of early rebleeding and corresponding complications within 6 wk after treatment were compared between both groups.Statistical methods were performed by two-sample t-test,Wilcoxon rank sum test andχ2 test.RESULTS No major variations were noted between the individuals of the two groups in terms of age,gender,Model for End-Stage Liver Disease score,coagulation function,serum albumin,hemoglobin,type of gastric varices,the dose of tissue glue injection and EV that needed to be treated simultaneously.The early rebleeding rate in PPI+APG group was 3.16%(3/95),which was much lower than that in the PPI group(12.87%,13/101)(P=0.013).Causes of early rebleeding:the incidence of gastric ulcer bleeding in the PPI+APG group was 2.11%(2/95),which was reduced in comparison to that in the PPI group(11.88%,12/101)(P=0.008);the incidence of venous bleeding in PPI+APG group and PPI group was 1.05%(1/95)and 0.99%(1/101),respectively,and there was no significant difference between them(0.999).The early mortality rate was 0 in both groups within 6 wk after the operation,and the low mortality rate was related to the timely hospitalization and active treatment of all patients with rebleeding.The overall incidence of complications in the PPI+APG group was 12.63%(12/95),which was not significantly different from 13.86%(14/101)in the PPI group(P=0.800).of abdominal pain in the PPI+APG group was 3.16%(3/95),which was lower than that in the PPI group(11.88%,12/101)(P=0.022).However,due to aluminum phosphate gel usage,the incidence of constipation in the PPI+APG group was 9.47%(9/95),which was higher than that in the PPI group(1.98%,2/101)(P=0.023),but the health of the patients could be improved by increasing drinking water or oral lactulose.No patients in either group developed spontaneous peritonitis after taking PPI,and none developed hepatic encephalopathy and ectopic embolism within 6 wk of EVHT treatment.CONCLUSION PPI combined with APG can significantly reduce the incidence of early rebleeding and postoperative abdominal pain in cirrhotic patients with GVB after taking EVHT.

Progress in the Early Mobilization of Patients after Cardiac Intervention

Early activity has a positive effect on the rehabilitation process of patients after cardiac intervention. This paper summarizes the concept and significance of early activity after cardiac intervention, the best time and mode of different types of early activity after cardiac intervention, and the factors affecting early activity, aiming to provide a basis for clinical medical staff to provide safe and effective guidance of early activity after cardiac intervention.

Postoperative serum tumor markers-based nomogram predicting early recurrence for patients undergoing radical resections of pancreatic ductal adenocarcinoma

BACKGROUND Early recurrence(ER)is associated with dismal outcomes in patients undergoing radical resection for pancreatic ductal adenocarcinoma(PDAC).Approaches for predicting ER will help clinicians in implementing individualized adjuvant therapies.Postoperative serum tumor markers(STMs)are indicators of tumor progression and may improve current systems for predicting ER.AIM To establish an improved nomogram based on postoperative STMs to predict ER in PDAC.METHODS We retrospectively enrolled 282 patients who underwent radical resection for PDAC at our institute between 2019 and 2021.Univariate and multivariate Cox regression analyses of variables with or without postoperative STMs,were performed to identify independent risk factors for ER.A nomogram was constructed based on the independent postoperative STMs.Receiver operating characteristic curve analysis was used to evaluate the area under the curve(AUC)of the nomogram.Survival analysis was performed using Kaplan-Meier survival plot and log-rank test.RESULTS Postoperative carbohydrate antigen 19-9 and carcinoembryonic antigen levels,preoperative carbohydrate antigen 125 levels,perineural invasion,and pTNM stage III were independent risk factors for ER in PDAC.The postoperative STMs-based nomogram(AUC:0.774,95%CI:0.713-0.835)had superior accuracy in predicting ER compared with the nomogram without postoperative STMs(AUC:0.688,95%CI:0.625-0.750)(P=0.016).Patients with a recurrence nomogram score(RNS)>1.56 were at high risk for ER,and had significantly poorer recurrence-free survival[median:3.08 months,interquartile range(IQR):1.80-8.15]than those with RNS≤1.56(14.00 months,IQR:6.67-24.80),P<0.001).CONCLUSION The postoperative STMs-based nomogram improves the predictive accuracy of ER in PDAC,stratifies the risk of ER,and identifies patients at high risk of ER for tailored adjuvant therapies.

Advances in early diagnosis and therapy of pancreatic cancer

BACKGROUND: Pancreatic cancer remains a devastating disease with a 5-year survival rate of less than 5%. Recent advances in diagnostic methods and therapeutic approaches have increased the possibility of improving the existing poor prognosis. DATA SOURCES: English-language articles reporting early diagnosis and therapy of pancreatic cancer were searched from the MEDLINE and PubMed databases, Chinese-language articles were from CHKD (China Hospital Knowledge Database) RESULT: The current literature about pancreatic cancer was reviewed from three aspects: statistics, screening and early detection, and therapy. CONCLUSIONS: Early detection and screening of pancreatic cancer currently should be limited to high risk patients Surgical resection is the only curative approach available, with some recent improvement in outcomes. Gemcitabine has been a standard treatment during the last decade. Gemcitabine based combination treatment, especially combined with newer molecular targeted agents, is promising. The rationale for radiotherapy is controversial, but with the recent development of modern radiation delivery techniques, radiotherapy should be intensified. Patients with borderline pancreatic cancer could benefit from neoadjuvant therapy but more evidence is needed and the best neoadjuvant regimen is still to be determined.

Effects of early rehabilitation therapy on patients with mechanical ventilation

BACKGROUND: For patients in intensive care unit(ICU), mechanical ventilation is an effective treatment to survive from acute illness and improve survival rates. However, long periods of bed rest and restricted physical activity can result in side effects. This study aimed to investigate the feasibility of early rehabilitation therapy in patients with mechanical ventilation.METHODS: A randomized controlled trial was carried out. Sixty patients, with tracheal intubation or tracheostomy more than 48 hours and less than 72 hours, were admitted to the ICU of the Affiliated Hospital of Medical College, Qingdao University, from May 2010 to May 2012. These patients were randomly divided into a rehabilitation group and a control group. In the rehabilitation group, rehabilitation therapy was performed twice daily, and the training time and intensity were adjusted according to the condition of the patients. Early rehabilitation therapy included heading up actively, transferring from the supine position to sitting position, sitting at the edge of the bed, sitting in chair, transferring from sitting to standing, and ambulating bedside. The patient's body mass index, days to first out of bed, duration of mechanical ventilation, length of ICU stay, APACHE II score, highest FiO2, lowest PaO2/FiO2 and hospital mortality of patients were all compared between the rehabilitation group and the control group. The differences between the two groups were compared using Student's t test.RESULTS: There was no significant difference in body mass index, APACHE II score, highest FiO2, lowest PaO2/FiO2 and hospital mortality between the rehabilitation group and the control group(P>0.05). Patients in the rehabilitation group had shorter days to first out of bed(3.8±1.2 d vs. 7.3±2.8 d; P=0.00), duration of mechanical ventilation(5.6±2.1 d vs. 12.7±4.1 d; P=0.005) and length of ICU stay(12.7±4.1 d vs. 15.2±4.5 d; P=0.01) compared with the control group.CONCLUSION: Early rehabilitation therapy was feasible and effective in improving the outcomes of patients with mechanical ventilation.

Feasible endoscopic therapy for early gastric cancer

AIM: To analyze the relationship between lymph node metastasis and clinical pathology of early gastric cancer(EGC) in order to provide criteria for a feasible endoscopic therapy.METHODS: Clinical data of the 525 EGC patients who underwent surgical operations between January 2009 and March 2014 in the West China Hospital of Sichuan University were analyzed retrospectively. Clinical pathological features were compared between different EGC patients with or without lymph node metastasis, and investigated by univariate and multivariate analyses for possible relationships with lymph node metastasis.RESULTS: Of the 2913 patients who underwent gastrectomy with lymph node dissection, 529 cases were pathologically proven to be EGC and 525 cases were enrolled in this study, excluding 4 cases of gastric stump carcinoma. Among 233 patients with mucosal carcinoma, 43(18.5%) had lymph node metastasis. Among 292 patients with submucosal carcinoma, 118(40.4%) had lymph nodemetastasis. Univariate analysis showed that gender, tumor size, invasion depth, differentiation type and lymphatic involvement correlated with a high risk of lymph node metastasis. Multivariate analysis revealed that gender(OR = 1.649, 95%CI: 1.091-2.492, P = 0.018), tumor size(OR = 1.803, 95%CI: 1.201-2.706, P = 0.004), invasion depth(OR = 2.566, 95%CI: 1.671-3.941, P = 0.000), histological differentiation(OR = 2.621, 95%CI: 1.624-4.230, P = 0.000) and lymphatic involvement(OR = 3.505, 95%CI: 1.590-7.725, P = 0.002) wereindependent risk factors for lymph node metastasis. Comprehensive analysis showed that lymph node metastasis was absent in patients with tumor that was limited to the mucosa, size ≤ 2 cm, differentiated and without lymphatic involvement.CONCLUSION: We propose an endoscopic therapy for EGC that is limited to the mucosa, size ≤ 2 cm, differentiated and without lymphatic involvement.

Endoscopic Mucosal Resection: Therapy for Early Colorectal Cancer

We review the use of Endoscopic Mucosal Resection in the treatment of early colorectal cancer. Newer endoscopic imaging modalities have lead to earlier detection of advanced lesions thus enabling endoscopic curative therapy of lesions that would otherwise need surgery. Early outcomes data suggest promising results. But further long term prospective studies are needed.

Early rehabilitation and neuroprotective drug therapy outcomes in elderly patients with acute stroke

Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, underwent early rehabilitation in combination with neuroprotective drug therapy. Limb movement, cognitive functions and daily life self-care ability in elderly patients upon admission and discharge were assessed using the Hunt-Hess scale, functional independence measures and mini-mental state examination. The mean duration of hospital stay among the 60 patients was 35 days. Upon discharge, 42 （75%） of the patients exhibited cognitive impairment to varying degrees, and 25 （45%） of the 56 stroke patients who underwent rehabilitation evaluation attained independence in daily living activities, 11 （20%） required intermittent supervision, and 20 （36%） required 24-hour constant supervision during performance of these activities. Results demonstrated that early rehabilitation treatment in combination with neuroprotective therapy for acute stroke was effective.

Youngest case of an early gastric cancer after successful eradication therapy

A 28-year-old woman visited our clinic with a chief complaint of epigastralgia. She had received successful Helicobacter pylori (H. pylori ) eradication therapy 5 years before. We repeated esophagogastroduodenoscopy, and a discolored depressed area with reddish spots and converging folds, 20 mm in size, was detected. No atrophic change including intestinal metaplasia or nodular gastritis was seen endoscopically. Two endoscopic biopsies revealed undifferentiated adenocarcinoma. No H. pylori was found, and the 13 C-urea breath test was also negative. Abdominal computed tomography demonstrated no nodal involvement, distant metastasis or fluid collection. She underwent a laparoscopyassisted distal gastrectomy. Histologically, the resected specimen revealed an early undifferentiated gastric cancer that had invaded deeply into the submucosal layer. Nodal involvement was histologically confirmed.No atrophic change or H. pylori infection was evident histologically. This is the youngest patient ever reported to have developed a node-positive early gastric cancer after eradication of H. pylori .

Use of Early Goal-Directed Therapy in the Emergency Department before and after the Sepsis Trilogy

The management of sepsis evolved recently with the publication of three large trials (referred to as the sepsis trilogy) investigating the efficacy of early goal-directed therapy (EGDT). Our goal was to determine if the publication of these trials has influenced the use of EGDT when caring for patients with severe sepsis and septic shock in the emergency department (ED). In February 2014, we surveyed a sample of board-certified emergency medicine physicians regarding their use of EGDT in the ED. A follow-up survey was sent after the publication of the sepsis trilogy. Data was analyzed using 95% confidence intervals to determine if there was a change in the use of EGDT following the publication of the above trials. Subgroup analyses were also performed with regard to academic affiliation and emergency department volume. Surveys were sent to 308 and 350 physicians in the pre-and post-publication periods, respectively. Overall, ED use of EGDT did not change with publication of the sepsis trilogy, 48.7% (CI 39.3% - 58.2%) before and 50.5% (CI 40.6% - 60.3%) after. Subgroup analysis revealed that academic-affiliated EDs significantly decreased EGDT use following the sepsis trilogy while nonacademic departments significantly increased EGDT use. Use of EGDT was significantly greater in community departments versus academic departments following the publication of the sepsis trilogy. There was no change overall in the use of EGDT protocols when caring for patients with severe sepsis and septic shock, but subgroup analyses revealed that academic departments decreased their use of EGDT while community departments increased use of EGDT. This may be due to varying rates of uptake of the medical literature between academic and community healthcare systems.

Effect of tea polyphenols combined with photodynamic therapy on the efficacy and RANKL and Shh levels in patients with early peri-implantitis

Objective: To analyze the effect of tea polyphenols combined with photodynamic therapy on the efficacy and RANKL and Shh levels in patients with early peri-implantitis. Methods:Eighty patients with early peri-implantitis admitted to our hospital from January 2017 to December 2018 were randomly divided into the observation group and the control group;the control group was treated with photodynamic therapy, and the observation group was treated with tea polyphenols combined with photodynamic therapy. The levels of mPLI, PPD, mSBI and BOP were measured before treatment and 3 months after the treatment, and the levels of CRP, TNF-α, IL-6, RANKL and Shh in the gingival crevicular fluid were measured. Results:The levels of mPLI, PPD, mSBI and BOP in the observation group were significantly lower than those in the control group, and the difference was statistically significant (P<0.05). The levels of CRP, TNF-α, IL-6, RANKL and Shh in the gingival crevicular fluid were observed in the observation group. The differences were significantly lower than the control group, and the difference was statistically significant (P<0.05). Conclusions: The combination of tea polyphenols and photodynamic therapy for patients with early peri-implantitis can significantly improve clinical efficacy and reduce the inflammatory response, and can effectively improve the levels of RANKL and Shh in gingival crevicular fluid.

CBASP Adapted to Child Play Therapy Structure to Prevent Early-Onset Persistent Depressive Disorder

The current paper is a theoretical proposal that interfaces the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and its emphasis on interpersonal consequences with the structured order of a Play Therapy Model for troubled 3 - 8-year-old children. This proposal is not a research paper or a review of literature;instead, it is a treatment proposal that is novel and untested. CBASP psychotherapy, an empirically validated treatment, was developed originally to treat the persistently depressed adult. CBASP’s major focus of interpersonal consequation will be interfaced with a Play Therapy structured model to rectify the maladaptive preoperational functioning of five interpersonal types of problem-children. The types are classified interpersonally using D.J. Kiesler’s Interpersonal Message Inventory (IMI). Kiesler’s IMI is employed in this proposal as an ongoing assessment modality, a source of information to make treatment strategy consequation decisions, and thirdly as an evaluative outcome variable. The troubled child types described herein frequently become candidates for early-onset Persistent Depressive Disorder (PDD) unless rescued by successful treatment. The origins of early-onset PDD arise in dysfunctional households where toxic interpersonal relationships predominate: where “survival from abuse,” not growth, describes the child’s modal developmental experiences. These children are often exposed to either serious traumas (e.g., sexual abuse, loss of a parent, physical abuse, physical or emotional neglect) or psychological insults (e.g., continuous, and chronic verbal and nonverbal abuse). The result, in the most serious cases, is a maturational stunting at the preoperational stage of development which, as noted above, if not successfully resolved, thrusts the child into early-onset PDD.

急性脑梗死患者溶栓后网膜素1水平对早期神经功能恶化的评估价值

目的探讨急性脑梗死患者溶栓后外周血网膜素1表达对早期神经功能恶化(early neurological deterioration,END)的评估价值。方法选取2021年2月至2022年2月郴州市第一人民医院神经内科明确诊断为急性脑梗死并行溶栓治疗的患者210例,根据溶栓后网膜素1水平分为低水平组70例(网膜素1<150μg/L),中水平组70例(150μg/L≤网膜素1≤200μg/L),高水平组70例(网膜素1>200μg/L),比较3组END发生情况。采用Pearson相关性分析网膜素1与END的相关性,用Cox回归分析发生END的影响因素,ROC曲线分析网膜素1对END的预测价值。结果210例急性脑梗死患者发生END 60例(28.6%)。低水平组、中水平组、高水平组END发生率比较,差异有统计学意义(45.7%vs 25.7%vs 14.3%,P<0.01),其中高水平组END发生率明显低于低水平组和中水平组,差异有统计学意义(P<0.01)。Pearson相关性分析显示,网膜素1与END发生呈负相关(r=-0.635,P<0.05)。多因素Cox回归分析显示,发病至溶栓时间、糖尿病、白细胞计数、网膜素1与急性脑梗死患者溶栓后发生END独立相关(P<0.05,P<0.01)。ROC曲线分析显示,网膜素1预测END发生的截断值为162.36μg/L,曲线下面积为0.868(95%CI:0.811~0.925),敏感性和特异性分别为73.3%、88.0%。结论急性脑梗死患者溶栓后外周血网膜素1水平与END的发生密切关联,网膜素1可作为评估END发生的生物标志物。

CT灌注成像对急性大核心脑梗死早期血管内治疗效果的预测效能

目的分析CT灌注成像对急性大核心脑梗死早期血管内治疗效果的预测效能。方法选择2018年10月至2022年11月在浙江省人民医院接受早期血管内治疗的急性大核心脑梗死患者54例,根据术后90 d改良Rankin量表(mRS)评分将患者分为预后良好组(观察组)23例和预后不良组(对照组)31例。收集并比较两组患者的一般资料及CT灌注成像等资料。采用多因素logistic回归分析CT灌注成像与急性大核心脑梗死早期血管内治疗临床预后的相关性。采用ROC曲线分析CT灌注成像对急性大核心脑梗死早期血管内治疗效果的预测效能。结果观察组NIHSS评分低于对照组,不匹配率高于对照组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,NIHSS评分和不匹配率均是急性大核心脑梗死早期血管内治疗预后的影响因素(均P<0.05)。ROC曲线显示,不匹配率预测急性大核心脑梗死早期血管内治疗预后良好的AUC为0.660(95%CI:0.509~0.811,P=0.046),最佳截断值为2.30,灵敏度为0.696,特异度为0.645。结论CT灌注成像与急性大核心脑梗死早期患者血管内治疗临床预后密切相关,有一定的预测效能。

早期精细化护理干预联合序贯式营养治疗对脑卒中后吞咽功能障碍患者的疗效观察

目的探讨早期精细化护理干预联合序贯式营养治疗对脑卒中后吞咽功能障碍患者的疗效。方法选取2021年1月至2023年6月四川大学华西医院收治的124例脑卒中后吞咽功能障碍患者为研究对象,在组间基线特征可比的原则上,采用随机数字表法分为对照组和观察组,每组62例。对照组给予常规护理干预联合常规营养治疗,观察组给予早期精细化护理干预联合序贯式营养治疗,两组患者均连续治疗3个月。比较分析两组患者治疗前后的吞咽功能、胃肠道屏障功能[二胺氧化酶(DAO)、D-乳酸]、营养状况[白蛋白(ALB)、血红蛋白(Hb)、转铁蛋白(TF)、前白蛋白(PA)]、心理状况与生活质量[症状自评量表-90(SCL-90)评分、吞咽障碍特异性生活质量量表(SWALQOL)评分]。结果治疗前,两组患者的吞咽功能比较差异均无统计学意义(P>0.05);治疗3个月后,两组患者的吞咽功能与治疗前比较均明显改善,且观察组优于对照组,差异均有统计学意义(P<0.05)。治疗前,两组患者的DAO、D-乳酸、ALB、Hb、TF、PA、SCL-90评分、SWAL-QOL评分比较差异均无统计学意义(P>0.05);治疗3个月后,两组患者的DAO、D-乳酸、SCL-90评分与治疗前比较均降低,且观察组低于对照组,差异均有统计学意义(P<0.05);治疗3个月后,两组患者的ALB、Hb、TF、PA、SWAL-QOL评分与治疗前比较均升高,且观察组高于对照组,差异均有统计学意义(P<0.05)。结论早期精细化护理干预联合序贯式营养治疗有利于改善脑卒中后吞咽功能障碍患者的吞咽功能、胃肠道屏障功能、营养状况及心理状况,且可提高患者的生活质量,值得临床应用。

早期肠内营养乳剂支持疗法治疗重症脑出血患者的临床研究

目的研究早期肠内营养支持疗法治疗重症脑出血患者的临床疗效及有效性分析。方法选择2021年10月至2023年2月期间于四川大学华西医院住院的108例重症脑出血患者作为研究对象,以随机数字表法分为对照组和观察组,每组各54例。对照组给予一般鼻饲饮食,观察组给予肠内营养乳剂,比较2组营养状况、急性生理与慢性健康评分(APACHEⅡ)、美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷量表(GCS)评分、肠黏膜屏障功能、免疫指标、并发症发生情况。结果治疗前,2组营养状况[血红蛋白(Hb)、总蛋白(TP)、白蛋白(ALB)]、APACHEⅡ评分、NIHSS评分、GCS评分、肠黏膜屏障功能[二胺氧化酶(DAO)、D-乳酸(D-LAC)、内毒素(ET)]、免疫指标[免疫球蛋白M(IgM)、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)]水平比较,差异无统计学意义(P>0.05);治疗2周后,观察组营养状况、APACHEⅡ评分、NIHSS评分、GCS评分、肠黏膜屏障功能、免疫指标水平较对照组更佳,差异有统计学意义(P<0.05);观察组并发症发生率为7.41%,较对照组的29.63%更低,差异有统计学意义(P<0.05)。结论对重症脑出血患者早期给予肠内营养乳剂,能够改善患者的营养状况、肠黏膜屏障功能,增强免疫力,减少并发症,减轻神经功能缺损,促进患者病情恢复,值得推广。

超声指导脓毒性休克液体复苏疗效的Meta分析

目的采用Meta分析比较超声指导液体复苏与早期目标导向治疗(EGDT)在脓毒性休克中的应用效果。方法通过计算机检索PubMed、Ovid、Scopus、Embase、Cochrane Library、Web of Science、中国知网(CNKI)、万方数据知识服务平台(WANFANG)、中国生物医学文献数据库(CBM)、维普中文科技期刊全文数据库(VIP)、中国临床实验数据中心和ClinicalTrials.gov,搜集从建库至2022年10月23日有关比较超声指导液体复苏和EGDT在脓毒性休克中应用效果的随机对照试验(RCT)。采用Review Manager5.3统计软件进行Meta分析。结果共纳入8篇文献,包括482例脓毒性休克患者,3篇文献风险偏移较低。Meta分析结果显示,两组的6、12、24 h乳酸清除率(LCR)、急性肾损伤(AKI)发生率、28 d病死率比较,差异无统计学意义(P>0.05);试验组的24 h复苏液体总量、24 h液体净平衡量低于对照组(P<0.00001);试验组的组织水肿发生率低于对照组(P=0.001);试验组的治疗6 h后每小时尿量多于对照组(P<0.00001);试验组的机械通气时间及ICU住院时间短于对照组,差异具有统计学意义(P=0.009、0.002)。结论超声指导脓毒性休克液体复苏可降低24 h复苏液体总量及组织水肿发生率,增加治疗6 h后每小时尿量,缩短机械通气时间及ICU住院时间。

关节镜双后内入路手术结合早期运动康复与物理治疗对后交叉韧带胫骨止点撕脱骨折膝关节功能的影响

目的探究关节镜双后内入路手术结合早期运动康复与物理治疗对后交叉韧带胫骨止点撕脱骨折膝关节功能的影响。方法前瞻性选取2020年4月至2022年4月在秦皇岛市第一医院接受关节镜双后内入路手术的后交叉韧带胫骨止点撕脱骨折患者90例,按照信封法将其分为研究组与对照组,每组各45例。在常规治疗的基础上,对照组接受物理治疗,研究组接受早期运动康复治疗。随访6个月,对两组患者术后疗效、下肢功能恢复情况(下床行走时间、住院时间、骨折愈合时间、术后下肢负重时间)、膝关节活动范围[屈曲角度、伸直受限角度及关节活动范围]、美国特种外科医院膝关节评分(HSS)量表(疼痛、功能、活动度、肌力、屈曲畸形及稳定性HSS)、患者满意度进行记录,并分析组间差异。结果研究组患者的治疗有效率为91.11%,高于对照组(75.56%),差异有统计学意义(P<0.05)。研究组患者下床行走时间、住院时间、骨折愈合时间、术后下肢负重时间均短于对照组,差异均有统计学意义(P<0.05)。治疗后6个月,两组患者的屈曲角度、关节活动范围均较治疗前增大,伸直受限角度均较治疗前减小,研究组屈曲角度、关节活动范围分别为(112.55±5.16)°、(108.66±11.02)°,均大于对照组[(97.89±4.51)°、(95.16±12.04)°],研究组伸直受限角度为(3.35±1.08)°,小于对照组[(4.89±1.62)°],差异均有统计学意义(P<0.05);治疗后6个月,两组患者在疼痛、功能、活动度、肌力、屈曲畸形及稳定性等方面的评分均较治疗前升高,且研究组在各方面的评分均高于对照组,差异均有统计学意义(P<0.05)。研究组患者的满意率为95.56%,高于对照组(80.00%),差异有统计学意义(P<0.05)。结论关节镜双后内入路手术结合早期运动康复对后交叉韧带胫骨止点撕脱骨折的治疗效果较好,可以明显改善患者的症状、促进愈合、提高膝关节功能,同时提高患者的满意度。

早期目标导向活动在ICU重症患者连续性肾脏替代治疗中的分析及对肾功能的影响

目的以在ICU接受连续性肾脏替代治疗(CRRT)的重症患者为研究对象,分析早期目标导向活动(EGDM)对其影响。方法收集2022年1月至2024年1月在我院行CRRT治疗的ICU重症患者100例,将2年内收治的患者信息均置入100封相同信封中,依次编号1~100号,其中50例单号者实施常规护理,作为对照组,另50例双号者实施EGDM护理,作为观察组,对比两组护理效果。结果观察组护理总有效率高于对照组(P<0.05);干预后,观察组肾功能、血流动力学指标改善情况优于对照组(P<0.05),功能量表评分及生活质量评分高于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论在ICU重症患者CRRT治疗中实施EGDM护理,可明显改善患者症状,减轻肾功能损害,缓解炎症,降低并发症的发生。