BACKGROUND Quantitative studies on the changes in inflammation-related content in tears,especially the effect of diabetes,are lacking.In this study,we measured the preoperative and postoperative tear inflammatory medi...BACKGROUND Quantitative studies on the changes in inflammation-related content in tears,especially the effect of diabetes,are lacking.In this study,we measured the preoperative and postoperative tear inflammatory mediator levels in cataract patients,focusing on the expression of inflammatory factors in postoperative cataracts in the diabetic,and investigated the effect of drugs on the control of postoperative inflammation.AIM To study the expression of inflammatory factors in elderly people with type 2 diabetes after cataract surgery.METHODS Patients with a mean age of 70.3±6.3 years were divided into group A(composed of elderly patients with cataracts and type 2 diabetes,n=20 eyes)and group B(patients with age-related cataract,n=20 eyes).Their tears were collected before each operation and on days 1 and 3,and weeks 1,2,3,and 4 post-surgery.Saline(150μL)was dropped into the conjunctival sac of the surgical eye,followed by oculogyration in four directions.The fluid in the conjunctival sac was extracted using a sterile syringe and stored in Eppendorf tubes at-80°C until measurement.The expression levels of matrix metalloproteinase-2(MMP-2),MMP-9,tissue inhibitor of metalloproteinase-1(TIMP-1),TIMP-2,interleukin-6(IL-6),and IL-20 in tear fluid were measured using enzyme-linked immunosorbent assays.RESULTS The postoperative expression levels of MMP-2,MMP-9,TIMP-2,IL-6,and IL-20 in group A were significantly higher than those in group B,whereas the concentration of TIMP-1 in group A remained lower than that in group B.The levels of MMP-2 and IL-6 in both groups continuously increased until the peak in the first postoperative week,and then gradually decreased over the next three weeks.Ultimately,MMP-2 declined to a lower level than that preoperatively at week 4,but IL-6 decreased to the same level as that preoperatively.The level of MMP-9 peaked in the first two weeks postoperative and then returned to the same level as 1-day post-operation.The concentration of TIMP-1 post-operation remained constant at a lower level than before surgery,and TIMP-2 Levels remained stable in both groups.IL-20 content started to increase in the third week after surgery.CONCLUSION Inflammatory factor levels in tears fluctuated before and post-operation,which indicated more severe postoperative inflammation in the first two weeks.展开更多
BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical sign...BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical significance.AIM To explore the clinical effect of recombinant human epidermal growth factor(rhEGF)plus sodium hyaluronate(SH)eye drops on DES after cataract surgery in patients with diabetes.METHODS We retrospectively evaluated 82 patients with diabetes who experienced DES after cataract surgery at Tianjin Beichen Hospital,Affiliated Hospital of Nankai University between April 2021 and April 2023.They were classified into an observation group(42 cases,rhEGF+SH eye drops)and a control group(40 cases,SH eye drops alone),depending on the different treatment schemes.The therapeutic efficacy,dry eye symptom score,tear film breakup time(TFBUT),basic tear secretion score[assessed using Schirmer I test(SIt)],corneal fluorescein staining(FL)score,tear inflammatory markers,adverse reactions during treat-ment,and treatment satisfaction were compared between the two groups.RESULTS Therapeutic efficacy was higher in the observation group compared with the control group.Both groups showed improved TFBUT and dry eye,as well as improved SIt and FL scores after treatment,with a more pronounced improvement in the observation group.Although no marked differences in adverse reactions were observed between the two groups,treatment satisfaction was higher in the observation group.CONCLUSION rhEGF+SH eye drops rendered clinical benefits to patients by effectively ameliorating dry eye and visual impairment with favorable efficacy,fewer adverse reactions,and high safety levels.Thus,this treatment should be promoted in clinical practice.展开更多
The intravenous use of nalmefene has been found to exert neuroprotective effect in patients with severe traumatic brain injury and acute cerebral infarction;nonetheless,it is unknown whether nalmefene alleviates delay...The intravenous use of nalmefene has been found to exert neuroprotective effect in patients with severe traumatic brain injury and acute cerebral infarction;nonetheless,it is unknown whether nalmefene alleviates delayed neurocognitive recovery.Our purpose of the current research was to clarify the impact of nalmefene on delayed neurocognitive recovery in aged patients experiencing video-assisted thoracic surgery(VATS)with intraoperative use of one lung ventilation(OLV).The present study involved 120 paticents undergoing selective VATS,randomized to accept low-dose nalmefene(N1 group,n=40),high-dose nalmefene(N2 group,1n=40)or equal volume of physiologic saline(control group,1=40).A battery of neuropsychological tests were used to estimate cognitive function I day before surgery(o)and 10 days after surgery or before discharge(t).Regional cerebral oxygen saturation(rSO2)was detected 5 min before induction(t),5 min after induction(1),15 and 60 min after onset of OLV(62 and 13),and 15 min after termination of OLV(4).The plasma values of interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-a1 and adiponectin(ADP)were also detected prior to induction of anesthesia(T0),1 h,2 h and 6 h after surgery(TI,T2,T3).On 1,delayed neurocognitive recovery occurred in 5/40(12.5%)patients of NI group,in 5/40(12.5%)patients of N2 group and in 13/40(32.5%)patients of control group(P<0.05).There were no statistical differences in rSO2 among three groups at different time points.At Tl,T2 and T3,IL-1β,IL-6 and TNF-a values significantly increased and ADP value significantly decreased(P<0.05)in control group.In contrast,at TI,T2 and T3,IL-1β,IL-6 and TNF-a values decreased and ADP value decreased less in N1 and N2 groups(P<0.05).At TI,T2 and T3,IL-1β,IL-6 and TNF-a concentrations presented a trend of N2 group<N1 group<control group and ADP presented a trend of N2 group>Nl group>control group(P<0.05).The result of our present research supports the hypothesis that the perioperative intravenous treatment with nalmefene to VATS with OLV ameliorates postoperative cognitive function and decreases the incidence of delayed neurocognitive recovery,most likely by suppression of inflammatory responses.展开更多
Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the ...Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.展开更多
AIM: To verify the safety and validity of laparoscopic surgery for the treatment of colorectal cancer in elderly patients.METHODS: A meta-analysis was performed of a systematic search of studies on an electronic datab...AIM: To verify the safety and validity of laparoscopic surgery for the treatment of colorectal cancer in elderly patients.METHODS: A meta-analysis was performed of a systematic search of studies on an electronic database. Studies that compared laparoscopic colectomy(LAC) in elderly colorectal cancer patients with open colectomy(OC) were retrieved, and their short and long-term outcomes compared. Elderly people were defined as 65 years old or more. Inclusion criteria were set at: Resection of colorectal cancer, comparison between laparoscopic and OC and no significant difference in backgrounds between groups.RESULTS: Fifteen studies were identified for analysis. LAC was performed on 1436 patients, and OC performed on 1810 patients. In analyses of short-term outcomes, operation time for LAC was longer than for OC(mean difference = 34.4162, 95%CI: 17.8473-50.9851, P < 0.0001). The following clinical parameters were lower in LAC than in OC: Amount of estimated blood loss(mean difference =-93.3738, 95%CI:-132.3437 to-54.4039, P < 0.0001), overall morbidity(OR = 0.5427, 95%CI: 0.4425-0.6655, P < 0.0001), incisional surgical site infection(OR = 0.6262, 95%CI: 0.4310-0.9097, P = 0.0140), bowel obstruction and ileus(OR = 0.6248, 95%CI: 0.4519-0.8638, P = 0.0044) and cardiovascular complications(OR = 0.4767, 95%CI: 0.2805-0.8101, P = 0.0062). In analyses of long-term outcomes(median follow-up period: 36.4 mo in LAC, 34.3 mo in OC), there was no significant difference in overall survival(mean difference = 0.8321, 95%CI: 0.5331-1.2990, P = 0.4187) and disease specific survival(mean difference = 1.0254, 95%CI: 0.6707-1.5675, P = 0.9209). There was also no significant difference in the number of dissected lymph nodes(mean difference =-0.1360, 95%CI:-4.0553-3.7833, P = 0.9458).CONCLUSION: LAC in elderly colorectal cancer patients had benefits in short-term outcomes compared with OC except operation time. The long-term outcomes and oncological clearance of LAC were similar to that of OC. These results support the assertion that LAC is an effective procedure for elderly patients with colorectal cancer.展开更多
Head and neck cancer(HNC) represents the sixth most common malignancy and accounts for approximately 6% of new cancer cases annually worldwide. As life expectancy constantly increases, the onset of HNC in patients old...Head and neck cancer(HNC) represents the sixth most common malignancy and accounts for approximately 6% of new cancer cases annually worldwide. As life expectancy constantly increases, the onset of HNC in patients older than 65 years of age at diagnosis is not rare and up to one fourth of cases occurs in patients older that 70 years at age. Because elderly cancer patients are severely under-represented in clinical trials, there is a clear need to address the particular aspects of this specific patient group, especially in the context of novel multidisciplinary therapeutic approaches. The frailty of elderly patients with HNC is attributed to the high incidence of smoking and alcohol abuse in this malignancy and the presence of substantial cardiovascular, respiratory or metabolic comorbidities. In the current work, I provide an overview of current and emerging treatment approaches, in elderly patients with HNC. In particular, I discuss modern surgical approaches that improve radical excision rates while preserving functionality, the incorporation of modern radiotherapeutic techniques and the introduction of novel chemotherapeutic combinations and molecular targeted agents in an effort to reduce toxicity without compromising efficacy. Finally, there is an urgent need to increase accrual and active participation of elderly patients with HNC in clinical trials, including biomarker evaluation in biopsy specimens towards an individualized therapeutic approach.展开更多
In the last decades, a trend towards a worldwide aging has been reported and diseases which are common in the elderly people would have important implications in clinical practice. Aortic stenosis (AS) is perhaps th...In the last decades, a trend towards a worldwide aging has been reported and diseases which are common in the elderly people would have important implications in clinical practice. Aortic stenosis (AS) is perhaps the most common and most often cause of sudden death among valvular heart diseases. Its prevalence is low among adults aged 〈 60 years, but increases to almost 10% in adults ≥ 80 years.[2] Since the degenerative calcific disease represents the lead- ing cause of AS in developed countries, the improved understanding on its pathogenesis (atherosclerotic processes and/or skeleton key) may offer potentially new targets for preventing and inhibiting AS development and progres- sion.[3] Patients with AS are generally asymptomatic for a prolonged period and the development of symptoms is a critical point in the natural history. Indeed, the prognosis changes dramatically with the onset of symptoms of angina,展开更多
Enhanced recovery after surgery (ERAS) has been used in various surgical professions in recent years and is widely accepted by doctors. This concept not only helps patients speed up postoperative recovery, reduce the ...Enhanced recovery after surgery (ERAS) has been used in various surgical professions in recent years and is widely accepted by doctors. This concept not only helps patients speed up postoperative recovery, reduce the incidence of related complications and shorten hospital stays, but also has been proved to be effective and safe in the perioperative application of gastric cancer. This article reviews the clinical application and research progress of enhanced recovery after surgery in the perioperative period of advanced gastric cancer in the elderly.展开更多
In the past,comparative effectiveness trials evaluating percutaneous coronary interventions(PCI),using either balloon angioplasty or bare metal stent(BMS) implantation,versus coronary artery bypass surgery(CABG) found...In the past,comparative effectiveness trials evaluating percutaneous coronary interventions(PCI),using either balloon angioplasty or bare metal stent(BMS) implantation,versus coronary artery bypass surgery(CABG) found similar survival rates at long-term follow-up with both revascularization strategies.Two major meta-analyses of these trials reported 5-and 6-year comparative effectiveness between PCI and CABG:one included only four trials that compared PCI with BMS implantation versus CABG whereas the largest one also included trials using balloon angioplasty.In these studies,the authors observed no survival differences between groups although a significant survival advantage was seen in diabetics treated with CABG and this benefit was also perceived in elderly patients.In both reports,number of involved vessels,presence of left anterior descending artery stenosis or poor left ventricular ejection fraction were no predictors of poor survival with PCI.Therefore,extent of the coronary artery disease(CAD) was not associated with poor outcome after PCI in the pre-drug eluting stent(DES) era.Recently,the ASCERT(Database Collaboration on the Comparative Effectiveness of Revascularization Strategies) registry found higher mortality rate with PCI in patients ≥ 65 years old in comparison with CABG,and advantages of surgery were seen in all subgroups including those at low risk.In this registry,PCI was accomplished by implantation of the first type of DES designs in 78% of cases.The intriguing observation of high mortality rate with PCI,including for non-diabetics and patients with two-vessel CAD,meaning a lack of clinical benefit with DES implantation,had not been seen previously.The study was not randomized,although its results are largely strengthened by its sample size.In this manuscript,the authors describe other registries and randomized trials reporting similar results supporting the findings of the aforementioned study and explore the reasons for these results,while also searching for potential solutions.展开更多
A best evidence topic was devised in light of a structured protocol. What is the advantage of (minl"mally invasive) approach in (frail patients) undergoing (aortic valve replacement)? In cardiac outpatient cl...A best evidence topic was devised in light of a structured protocol. What is the advantage of (minl"mally invasive) approach in (frail patients) undergoing (aortic valve replacement)? In cardiac outpatient clinic you review an 85-year old male with severe aortic valve stenosis, low left ventricular ejection fraction and creatinine clearance of less than 50 mL/min. Other comorbidities include treated pulmonary hypertension, mild cognitive impairment, marked limitation of ordinary physical activity and depression. You resolve to determine whether to recommend mim'mally invasive or conventional aortic valve replacement (AVR) or transcathe- ter aortic valve implantation (TAVI), however you are not sure of the differences of the impact of frailty on preopera- tive risk for each approach; hence you investigate the best evidence on the topic.展开更多
BACKGROUND Several studies have shown the safety,feasibility and oncologic adequacy of robotic right hemicolectomy(RRH).Laparoscopic right hemicolectomy(LRH)is considered technically challenging.Robotic surgery has be...BACKGROUND Several studies have shown the safety,feasibility and oncologic adequacy of robotic right hemicolectomy(RRH).Laparoscopic right hemicolectomy(LRH)is considered technically challenging.Robotic surgery has been introduced to overcome this technical limitation,but it is related to high costs.To maximize the benefits of such surgery,only selected patients are candidates for this technique.In addition,due to progressive aging of the population,an increasing number of minimally invasive procedures are performed on elderly patients with severe comorbidities,who are usually more prone to post-operative complications.AIM To investigate the outcomes of RRH vs LRH with regard to age and comorbidities.METHODS We retrospectively analyzed 123 minimally invasive procedures(68 LRHs vs 55 RRHs)for right colon cancer or endoscopically unresectable adenoma performed in our Center from January 2014 until September 2019.The surgical procedures were performed according to standardized techniques.The primary clinical outcome of the study was the length of hospital stay(LOS)measured in days.Secondary outcomes were time to first flatus(TFF)and time to first stool evacuation.The robotic technique was considered the exposure and the laparoscopic technique was considered the control.Routine demographic variables were obtained,including age at time of surgery and gender.Body mass index and American Society of Anesthesiologists physical status were registered.The age-adjusted Charlson Comorbidity Index(ACCI)was calculated;the tumornode-metastasis system,intra-operative variables and post-operative complications were recorded.Post-operative follow-up was 180 d.RESULTS LOS,TFF,and time to first stool were significantly shorter in the robotic group:Median 6[interquartile range(IQR)5-8]vs 7(IQR 6-10.5)d,P=0.028;median 2(IQR 1-3)vs 3(IQR 2-4)d,P<0.001;median 4(IQR 3-5)vs 5(IQR 4-6.5)d,P=0.005,respectively.Following multivariable analysis,the robotic technique was confirmed to be predictive of significantly shorter hospitalization and faster restoration of bowel function;in addition the dichotomous variables of age over75 years and ACCI more than 7 were significant predictors of hospital stay.No outcomes were significantly associated with Clavien-Dindo grading.Sub-group analysis demonstrated that patients aged over 75 years had a longer LOS(median6-IQR 5-8-vs 7-IQR 6-12-d,P=0.013)and later TFF(median 2-IQR 1-3-vs 3-IQR 2-4-d,P=0.008),while patients with ACCI more than 7 were only associated with a prolonged hospital stay(median 7-IQR 5-8-vs 7-IQR 6-14.5-d,P=0.036).CONCLUSION RRH is related to shorter LOS when compared with the laparoscopic approach,but older age and several comorbidities tend to reduce its benefits.展开更多
目的研究石杉碱甲对老年患者腹部手术后认知功能障碍的影响。方法收集行择期腹部手术的老年患者100例,ASAⅠ~Ⅱ级,年龄65岁~86岁,无神经、精神系统疾病史。治疗组患者50例,麻醉前静脉注射石杉碱甲注射液0.2mg,对照组50例注射等容量(1...目的研究石杉碱甲对老年患者腹部手术后认知功能障碍的影响。方法收集行择期腹部手术的老年患者100例,ASAⅠ~Ⅱ级,年龄65岁~86岁,无神经、精神系统疾病史。治疗组患者50例,麻醉前静脉注射石杉碱甲注射液0.2mg,对照组50例注射等容量(1mL)的生理氯化钠溶液。观察两组患者术前、术后8、12、24h、术后1周的认知功能,采用简易智能状态检查法(Mini-Mental State Examination,MMSE)测试,观察两组患者术后认知功能障碍、术后谵妄的发生情况及苏醒时间。结果两组患者术前MMSE评分无显著差异;与术前比较,对照组术后各时间点的MMSE评分均下降(P<0.05),治疗组于术后1、12、24h下降(P<0.05),但术后1周与术前无显著差异(P>0.05);两组间比较治疗组术后各时点的MMSE评分均高于对照组(P<0.05)。术后认知功能障碍和术后谵妄的发生率治疗组明显低于对照组(P<0.05)。苏醒时间两组间无显著性差异(P>0.05)。结论围术期应用石杉碱甲注射液可减少老年患者全麻术后认知功能的损害,降低术后认知功能障碍的发生。展开更多
基金Supported by Cataract Prevention and Control Appropriate Technology Base of Sichuan Provincial Health Commission(Regional Demonstration),No.2022JDXM012。
文摘BACKGROUND Quantitative studies on the changes in inflammation-related content in tears,especially the effect of diabetes,are lacking.In this study,we measured the preoperative and postoperative tear inflammatory mediator levels in cataract patients,focusing on the expression of inflammatory factors in postoperative cataracts in the diabetic,and investigated the effect of drugs on the control of postoperative inflammation.AIM To study the expression of inflammatory factors in elderly people with type 2 diabetes after cataract surgery.METHODS Patients with a mean age of 70.3±6.3 years were divided into group A(composed of elderly patients with cataracts and type 2 diabetes,n=20 eyes)and group B(patients with age-related cataract,n=20 eyes).Their tears were collected before each operation and on days 1 and 3,and weeks 1,2,3,and 4 post-surgery.Saline(150μL)was dropped into the conjunctival sac of the surgical eye,followed by oculogyration in four directions.The fluid in the conjunctival sac was extracted using a sterile syringe and stored in Eppendorf tubes at-80°C until measurement.The expression levels of matrix metalloproteinase-2(MMP-2),MMP-9,tissue inhibitor of metalloproteinase-1(TIMP-1),TIMP-2,interleukin-6(IL-6),and IL-20 in tear fluid were measured using enzyme-linked immunosorbent assays.RESULTS The postoperative expression levels of MMP-2,MMP-9,TIMP-2,IL-6,and IL-20 in group A were significantly higher than those in group B,whereas the concentration of TIMP-1 in group A remained lower than that in group B.The levels of MMP-2 and IL-6 in both groups continuously increased until the peak in the first postoperative week,and then gradually decreased over the next three weeks.Ultimately,MMP-2 declined to a lower level than that preoperatively at week 4,but IL-6 decreased to the same level as that preoperatively.The level of MMP-9 peaked in the first two weeks postoperative and then returned to the same level as 1-day post-operation.The concentration of TIMP-1 post-operation remained constant at a lower level than before surgery,and TIMP-2 Levels remained stable in both groups.IL-20 content started to increase in the third week after surgery.CONCLUSION Inflammatory factor levels in tears fluctuated before and post-operation,which indicated more severe postoperative inflammation in the first two weeks.
基金Supported by Tianjin Health Research Project,No.TJWJ2023MS062。
文摘BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical significance.AIM To explore the clinical effect of recombinant human epidermal growth factor(rhEGF)plus sodium hyaluronate(SH)eye drops on DES after cataract surgery in patients with diabetes.METHODS We retrospectively evaluated 82 patients with diabetes who experienced DES after cataract surgery at Tianjin Beichen Hospital,Affiliated Hospital of Nankai University between April 2021 and April 2023.They were classified into an observation group(42 cases,rhEGF+SH eye drops)and a control group(40 cases,SH eye drops alone),depending on the different treatment schemes.The therapeutic efficacy,dry eye symptom score,tear film breakup time(TFBUT),basic tear secretion score[assessed using Schirmer I test(SIt)],corneal fluorescein staining(FL)score,tear inflammatory markers,adverse reactions during treat-ment,and treatment satisfaction were compared between the two groups.RESULTS Therapeutic efficacy was higher in the observation group compared with the control group.Both groups showed improved TFBUT and dry eye,as well as improved SIt and FL scores after treatment,with a more pronounced improvement in the observation group.Although no marked differences in adverse reactions were observed between the two groups,treatment satisfaction was higher in the observation group.CONCLUSION rhEGF+SH eye drops rendered clinical benefits to patients by effectively ameliorating dry eye and visual impairment with favorable efficacy,fewer adverse reactions,and high safety levels.Thus,this treatment should be promoted in clinical practice.
基金This study was supported by grants from the Innovation Foundation of Health and Family Planning Commission of Hubei Province(No.WJ2017M036)the National Natural Science Foundation of China(No.81471858).
文摘The intravenous use of nalmefene has been found to exert neuroprotective effect in patients with severe traumatic brain injury and acute cerebral infarction;nonetheless,it is unknown whether nalmefene alleviates delayed neurocognitive recovery.Our purpose of the current research was to clarify the impact of nalmefene on delayed neurocognitive recovery in aged patients experiencing video-assisted thoracic surgery(VATS)with intraoperative use of one lung ventilation(OLV).The present study involved 120 paticents undergoing selective VATS,randomized to accept low-dose nalmefene(N1 group,n=40),high-dose nalmefene(N2 group,1n=40)or equal volume of physiologic saline(control group,1=40).A battery of neuropsychological tests were used to estimate cognitive function I day before surgery(o)and 10 days after surgery or before discharge(t).Regional cerebral oxygen saturation(rSO2)was detected 5 min before induction(t),5 min after induction(1),15 and 60 min after onset of OLV(62 and 13),and 15 min after termination of OLV(4).The plasma values of interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-a1 and adiponectin(ADP)were also detected prior to induction of anesthesia(T0),1 h,2 h and 6 h after surgery(TI,T2,T3).On 1,delayed neurocognitive recovery occurred in 5/40(12.5%)patients of NI group,in 5/40(12.5%)patients of N2 group and in 13/40(32.5%)patients of control group(P<0.05).There were no statistical differences in rSO2 among three groups at different time points.At Tl,T2 and T3,IL-1β,IL-6 and TNF-a values significantly increased and ADP value significantly decreased(P<0.05)in control group.In contrast,at TI,T2 and T3,IL-1β,IL-6 and TNF-a values decreased and ADP value decreased less in N1 and N2 groups(P<0.05).At TI,T2 and T3,IL-1β,IL-6 and TNF-a concentrations presented a trend of N2 group<N1 group<control group and ADP presented a trend of N2 group>Nl group>control group(P<0.05).The result of our present research supports the hypothesis that the perioperative intravenous treatment with nalmefene to VATS with OLV ameliorates postoperative cognitive function and decreases the incidence of delayed neurocognitive recovery,most likely by suppression of inflammatory responses.
文摘Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.
文摘AIM: To verify the safety and validity of laparoscopic surgery for the treatment of colorectal cancer in elderly patients.METHODS: A meta-analysis was performed of a systematic search of studies on an electronic database. Studies that compared laparoscopic colectomy(LAC) in elderly colorectal cancer patients with open colectomy(OC) were retrieved, and their short and long-term outcomes compared. Elderly people were defined as 65 years old or more. Inclusion criteria were set at: Resection of colorectal cancer, comparison between laparoscopic and OC and no significant difference in backgrounds between groups.RESULTS: Fifteen studies were identified for analysis. LAC was performed on 1436 patients, and OC performed on 1810 patients. In analyses of short-term outcomes, operation time for LAC was longer than for OC(mean difference = 34.4162, 95%CI: 17.8473-50.9851, P < 0.0001). The following clinical parameters were lower in LAC than in OC: Amount of estimated blood loss(mean difference =-93.3738, 95%CI:-132.3437 to-54.4039, P < 0.0001), overall morbidity(OR = 0.5427, 95%CI: 0.4425-0.6655, P < 0.0001), incisional surgical site infection(OR = 0.6262, 95%CI: 0.4310-0.9097, P = 0.0140), bowel obstruction and ileus(OR = 0.6248, 95%CI: 0.4519-0.8638, P = 0.0044) and cardiovascular complications(OR = 0.4767, 95%CI: 0.2805-0.8101, P = 0.0062). In analyses of long-term outcomes(median follow-up period: 36.4 mo in LAC, 34.3 mo in OC), there was no significant difference in overall survival(mean difference = 0.8321, 95%CI: 0.5331-1.2990, P = 0.4187) and disease specific survival(mean difference = 1.0254, 95%CI: 0.6707-1.5675, P = 0.9209). There was also no significant difference in the number of dissected lymph nodes(mean difference =-0.1360, 95%CI:-4.0553-3.7833, P = 0.9458).CONCLUSION: LAC in elderly colorectal cancer patients had benefits in short-term outcomes compared with OC except operation time. The long-term outcomes and oncological clearance of LAC were similar to that of OC. These results support the assertion that LAC is an effective procedure for elderly patients with colorectal cancer.
文摘Head and neck cancer(HNC) represents the sixth most common malignancy and accounts for approximately 6% of new cancer cases annually worldwide. As life expectancy constantly increases, the onset of HNC in patients older than 65 years of age at diagnosis is not rare and up to one fourth of cases occurs in patients older that 70 years at age. Because elderly cancer patients are severely under-represented in clinical trials, there is a clear need to address the particular aspects of this specific patient group, especially in the context of novel multidisciplinary therapeutic approaches. The frailty of elderly patients with HNC is attributed to the high incidence of smoking and alcohol abuse in this malignancy and the presence of substantial cardiovascular, respiratory or metabolic comorbidities. In the current work, I provide an overview of current and emerging treatment approaches, in elderly patients with HNC. In particular, I discuss modern surgical approaches that improve radical excision rates while preserving functionality, the incorporation of modern radiotherapeutic techniques and the introduction of novel chemotherapeutic combinations and molecular targeted agents in an effort to reduce toxicity without compromising efficacy. Finally, there is an urgent need to increase accrual and active participation of elderly patients with HNC in clinical trials, including biomarker evaluation in biopsy specimens towards an individualized therapeutic approach.
文摘In the last decades, a trend towards a worldwide aging has been reported and diseases which are common in the elderly people would have important implications in clinical practice. Aortic stenosis (AS) is perhaps the most common and most often cause of sudden death among valvular heart diseases. Its prevalence is low among adults aged 〈 60 years, but increases to almost 10% in adults ≥ 80 years.[2] Since the degenerative calcific disease represents the lead- ing cause of AS in developed countries, the improved understanding on its pathogenesis (atherosclerotic processes and/or skeleton key) may offer potentially new targets for preventing and inhibiting AS development and progres- sion.[3] Patients with AS are generally asymptomatic for a prolonged period and the development of symptoms is a critical point in the natural history. Indeed, the prognosis changes dramatically with the onset of symptoms of angina,
文摘Enhanced recovery after surgery (ERAS) has been used in various surgical professions in recent years and is widely accepted by doctors. This concept not only helps patients speed up postoperative recovery, reduce the incidence of related complications and shorten hospital stays, but also has been proved to be effective and safe in the perioperative application of gastric cancer. This article reviews the clinical application and research progress of enhanced recovery after surgery in the perioperative period of advanced gastric cancer in the elderly.
文摘In the past,comparative effectiveness trials evaluating percutaneous coronary interventions(PCI),using either balloon angioplasty or bare metal stent(BMS) implantation,versus coronary artery bypass surgery(CABG) found similar survival rates at long-term follow-up with both revascularization strategies.Two major meta-analyses of these trials reported 5-and 6-year comparative effectiveness between PCI and CABG:one included only four trials that compared PCI with BMS implantation versus CABG whereas the largest one also included trials using balloon angioplasty.In these studies,the authors observed no survival differences between groups although a significant survival advantage was seen in diabetics treated with CABG and this benefit was also perceived in elderly patients.In both reports,number of involved vessels,presence of left anterior descending artery stenosis or poor left ventricular ejection fraction were no predictors of poor survival with PCI.Therefore,extent of the coronary artery disease(CAD) was not associated with poor outcome after PCI in the pre-drug eluting stent(DES) era.Recently,the ASCERT(Database Collaboration on the Comparative Effectiveness of Revascularization Strategies) registry found higher mortality rate with PCI in patients ≥ 65 years old in comparison with CABG,and advantages of surgery were seen in all subgroups including those at low risk.In this registry,PCI was accomplished by implantation of the first type of DES designs in 78% of cases.The intriguing observation of high mortality rate with PCI,including for non-diabetics and patients with two-vessel CAD,meaning a lack of clinical benefit with DES implantation,had not been seen previously.The study was not randomized,although its results are largely strengthened by its sample size.In this manuscript,the authors describe other registries and randomized trials reporting similar results supporting the findings of the aforementioned study and explore the reasons for these results,while also searching for potential solutions.
文摘A best evidence topic was devised in light of a structured protocol. What is the advantage of (minl"mally invasive) approach in (frail patients) undergoing (aortic valve replacement)? In cardiac outpatient clinic you review an 85-year old male with severe aortic valve stenosis, low left ventricular ejection fraction and creatinine clearance of less than 50 mL/min. Other comorbidities include treated pulmonary hypertension, mild cognitive impairment, marked limitation of ordinary physical activity and depression. You resolve to determine whether to recommend mim'mally invasive or conventional aortic valve replacement (AVR) or transcathe- ter aortic valve implantation (TAVI), however you are not sure of the differences of the impact of frailty on preopera- tive risk for each approach; hence you investigate the best evidence on the topic.
文摘BACKGROUND Several studies have shown the safety,feasibility and oncologic adequacy of robotic right hemicolectomy(RRH).Laparoscopic right hemicolectomy(LRH)is considered technically challenging.Robotic surgery has been introduced to overcome this technical limitation,but it is related to high costs.To maximize the benefits of such surgery,only selected patients are candidates for this technique.In addition,due to progressive aging of the population,an increasing number of minimally invasive procedures are performed on elderly patients with severe comorbidities,who are usually more prone to post-operative complications.AIM To investigate the outcomes of RRH vs LRH with regard to age and comorbidities.METHODS We retrospectively analyzed 123 minimally invasive procedures(68 LRHs vs 55 RRHs)for right colon cancer or endoscopically unresectable adenoma performed in our Center from January 2014 until September 2019.The surgical procedures were performed according to standardized techniques.The primary clinical outcome of the study was the length of hospital stay(LOS)measured in days.Secondary outcomes were time to first flatus(TFF)and time to first stool evacuation.The robotic technique was considered the exposure and the laparoscopic technique was considered the control.Routine demographic variables were obtained,including age at time of surgery and gender.Body mass index and American Society of Anesthesiologists physical status were registered.The age-adjusted Charlson Comorbidity Index(ACCI)was calculated;the tumornode-metastasis system,intra-operative variables and post-operative complications were recorded.Post-operative follow-up was 180 d.RESULTS LOS,TFF,and time to first stool were significantly shorter in the robotic group:Median 6[interquartile range(IQR)5-8]vs 7(IQR 6-10.5)d,P=0.028;median 2(IQR 1-3)vs 3(IQR 2-4)d,P<0.001;median 4(IQR 3-5)vs 5(IQR 4-6.5)d,P=0.005,respectively.Following multivariable analysis,the robotic technique was confirmed to be predictive of significantly shorter hospitalization and faster restoration of bowel function;in addition the dichotomous variables of age over75 years and ACCI more than 7 were significant predictors of hospital stay.No outcomes were significantly associated with Clavien-Dindo grading.Sub-group analysis demonstrated that patients aged over 75 years had a longer LOS(median6-IQR 5-8-vs 7-IQR 6-12-d,P=0.013)and later TFF(median 2-IQR 1-3-vs 3-IQR 2-4-d,P=0.008),while patients with ACCI more than 7 were only associated with a prolonged hospital stay(median 7-IQR 5-8-vs 7-IQR 6-14.5-d,P=0.036).CONCLUSION RRH is related to shorter LOS when compared with the laparoscopic approach,but older age and several comorbidities tend to reduce its benefits.
文摘目的研究石杉碱甲对老年患者腹部手术后认知功能障碍的影响。方法收集行择期腹部手术的老年患者100例,ASAⅠ~Ⅱ级,年龄65岁~86岁,无神经、精神系统疾病史。治疗组患者50例,麻醉前静脉注射石杉碱甲注射液0.2mg,对照组50例注射等容量(1mL)的生理氯化钠溶液。观察两组患者术前、术后8、12、24h、术后1周的认知功能,采用简易智能状态检查法(Mini-Mental State Examination,MMSE)测试,观察两组患者术后认知功能障碍、术后谵妄的发生情况及苏醒时间。结果两组患者术前MMSE评分无显著差异;与术前比较,对照组术后各时间点的MMSE评分均下降(P<0.05),治疗组于术后1、12、24h下降(P<0.05),但术后1周与术前无显著差异(P>0.05);两组间比较治疗组术后各时点的MMSE评分均高于对照组(P<0.05)。术后认知功能障碍和术后谵妄的发生率治疗组明显低于对照组(P<0.05)。苏醒时间两组间无显著性差异(P>0.05)。结论围术期应用石杉碱甲注射液可减少老年患者全麻术后认知功能的损害,降低术后认知功能障碍的发生。