Occurrence Rate Of Complications Research Articles

Influence of functional training and psychological support based nursing intervention on the recovery of tibiofibular fracture patients

Objective To investigate the influence of functional training and psychological support based nursing intervention on the recovery of tibiofibular fracture patients. Methods A total of 30 tibiofibular fracture patients received in the orthopedics department of this hospital from January, 2014 to December, 2015 were selected, divided into control group and observation group (15 patients each) according to random number table.Routine nursing was given to the patients of two groups after fracture operation.Functional training and psychological support based nursing intervention was given to observation group based on routine nursing.The excellent and good rate, life quality score, pain score, satisfaction and complication occurrence rate of limb function recovery were compared to the patients of both groups after nursing. Results The excellent and good rate, life quality score of limb function recovery of patients in observation group were higher than control group.VAS score, SAS score and SDS score were lower than control group, and the satisfaction of nursing service was higher than control group.The total occurrence rate of postoperative complication was lower than control group.The comparative difference had statistical significance(P<0.05). Conclusions Functional training and psychological support based nursing intervention can effectively promote the recovery of postoperative limb function for tibiofibular fracture patients, reduce the occurrence of complication, improve life quality and nursing satisfaction, which is worth having clinical popularization and application. Key words: Tibiofibular fracture; Nursing interventions; Exercise; Psychological support

Application of nursing information IIFAR scheme to PICC cathetering patients

Objective To discuss about the application effect of nursing information IIFAR scheme to PICC cathetering patients. Methods A total of 100 PICC cathetering patients were divided into experimental group and control group randomly in average.Conventional health education was given to control group, and IIFAR health education mode was given to experimental group on this basis.Afterwards, the complication occurrence rate, relevant knowledge acquisition level and compliance were compared for the patients between two groups. Results The infection occurrence rate of puncture site of the observation group was lower than that of the control group. The thrombogenesis occurrence rate of the observation group was lower than that of the control group. The relevant knowledge acquisition and compliance of patients in observation group were apparently higher than that of the control group. Conclusion The nursing information IIFAR scheme can improve the relevant knowledge acquisition and compliance and reduce complications for PICC patients. Key words: Nursing information IIFAR scheme; PICC; Complications; Compliance

Nursing on drug-induced hepatic failure patients after artificial liver plasma exchange

Objective To observe the clinical effect of drug-induced hepatic failure patients after artificial liver plasma exchange and observe the nursing control measures of relevant complications. Methods Retrospective research method was used. In addition, the clinical basic information of 100 drug-induced hepatic failure patients hospitalized in the internal infection medicine of this hospital from July 2012 to July 2015 was collected. On the basis of giving conventional treatment to 100 patients (such as lowering transaminase, removing jaundice and hepatic protection, etc), artificial liver plasma exchange treatment was given. The coagulation functions before and after treatment, the dynamic change of the correlated indices of liver function and subjective symptoms (such as poor appetite, nausea and stomachache, etc) of patients were observed.In addition, the relevant complications were further concluded after artificial liver plasma exchange was conducted.In addition, the factors of complications and relevant nursing control method were discussed. Results After artificial liver plasma exchange treatment was conducted, poor appetite, nausea, stomachache and other discomforts of most patients were significantly relieved.The vital signs were significantly improved compared with before. The serum alanine aminotransferase and total bilirubin were significantly reduced after artificial liver treatment for the patients.Compared with the condition before treatment, the difference had statistical significance(P<0.05). The albumin and coagulation function of patients were significantly improved after treatment.Compared with the condition before treatment, the difference had statistical significance(P<0.05). The occurrence rates of relevant complications after treatment were below: allergic to plasma (11 cases, the percentage was 11%), blood pressure reduced (5 cases, the percentage was 5%) and bleeding in intubation (2 cases, the percentage was 11%). Conclusions Artificial liver plasma exchange treatment can significantly improve the liver functions of drug-induced hepatic failure patients, by which the treatment success rate of drug-induced hepatic failure patients can be greatly promoted, which is worth having clinical popularization and application. Key words: Drug-induced hepatic failure; Artificial liver plasma exchange; Nursing; Complications

Percutaneous ultrasound-guided fiducial marker placement for liver cancer robotic stereotactic radio-surgery treatment: A comparative analysis of three types of markers and needles

Background and study aimsPercutaneous placement of fiducial markers is required to perform stereotactic body radiation therapy (SBRT) for liver neoplastic lesions. This prospective trial was designed to evaluate the feasibility and safety of percutaneous ultrasound-guided placement of three different types of markers in patients with liver cancer referred for SBRT. Patients and methodsFifty patients underwent percutaneous ultrasound-guided implantation of a fiducial marker in the liver. Three sizes of needles were used: 25 gauge (G), 22G, and 17G. The 25G and 22G needles contained gold anchor markers of 0.28×10mm and 0.4 ×10mm size, respectively. In contrast, the 17G needle contained a gold grain marker of 1×4mm. Each patient received 1–6 markers, depending on lesion size and numbers. Technical feasibility and the occurrence of adverse events were registered. Computed tomography scans were acquired prior to SBRT to evaluate the location, visibility, or complications related to the markers. ResultsA total of 163 needles were used to deliver 163 markers in 50 patients. No major complications occurred. Minor complication occurrence rate was 12%. The total complication occurrence for all type of markers was 8.5%. No complications were observed with the use of the gold anchor marker of 0.4 ×10mm size. Variance analysis of the three markers showed a significant difference in the frequency of complications amongst the three markers (p<0.01). ConclusionPercutaneous ultrasound-guided placement of fiducial markers for SBRT of liver neoplastic lesions is safe and feasible. In our series, the 22G needle showed some advantage in terms of handling and safety when compared with the 25G and 17G needles. In addition, the gold anchor marker of 0.4 ×10mm size displayed a lower percentage of displacement.

Clinical analysis of delayed papillary hemorrhage after endoscopic retrograde cholangiopancreatography

Objective To evaluate the clinical feature and potential reasons of delayed papillary bleeding after endoscopic retrograde cholangiopancreatography (ERCP), and search for effective hemostasis and strategies. Methods A total of 76 patients with post-ERCP bleeding underwent endoscopic treatment in the Eastern Hepatobiliary Hospital from August 2000 to August 2016. Clinical data, haemostatic methods, and treatment outcomes of patients were retrospectively analyzed. Results Delayed papillary hemorrhage mostly occurred within 48 hours after ERCP (67.2%, 45/67), with main manifestations of hematemesis, bloody stool, and bile. The lowest incidence of delayed bleeding was detected after endoscopic papillary balloon dilation (EPBD, 0.1%), which was followed by papillary precut (0.6%) and endoscopic sphincterotomy (EST, 0.9%). And EST+ EPBD had the highest incidence of delayed post-ERCP papillary hemorrhage (2.4%). The most bleeding site was the left side of the incision (67.1%, 51/76). Emergent endoscopic interventions were applied in all patients with success of hemostasis in 71 out of 76 (93.4%), and injection with diluted epinephrine, electric coagulation, hemoclipping, and metal stenting were used sequentially for hemostasis. Among the 71 successful cases of hemostasis, 66 patients were performed endoscopic hemostasis for once, 4 patients took twice, and 1 case took thrice. Endoscopic hemoclipping was the most commonly used method with successful rate of 76.9% (50/65) for hemostasis. Conclusion Precut papillotomy is safe and effective, and its complication occurrence rate is similar to that of EST. Hemorrhage should be prevented and timely dealt with in small/median EST and/or EPBD. Once hemorrhage is suspected clinically, endoscopic inventions should be applied timely, and hemoclipping is a safe and effective method. Key words: Cholangiopancreatography, endoscopic retrograde; Sphincterotomy, endoscopic; Endoscopic papillary balloon dilation; Delayed bleeding; Hemostasis

Deriving literature-based benchmarks for surgical complications in high-income countries: a protocol for a systematic review and meta-analysis

IntroductionTo improve surgical safety, health systems must identify preventable adverse outcomes and measure changes in these outcomes in response to quality improvement initiatives. This requires understanding of the scope and...

Effect of three-dimensional reconstruction-assisted 23G micro-invasive vitrectomy in patients with proliferative diabetic retinopathy.

In the present study, we investigated the effect of optical coherence tomography (OCT) three-dimensional reconstruction-assisted 23G micro-invasive vitrectomy (abbreviated to‘23G’) in patients with proliferative diabetic retinopathy (PDR). A total of 66 PDR patients (66 eyes) were continuously selected and randomly divided into the control and observation groups with 33 patients in each group. Patients in the control group were treated with routine OCT examination while the patients in the observation group were treated with OCT three-dimensional retinal reconstruction. The 23G surgical method was applied to the two groups, and a comparison was made on the clinical effects in the two groups. The follow-up visits lasted for approximately 6 months, and it was found that the operative time, occurrence rate of intraoperative complications and postoperative complications as shown in the observation group were significantly less than those in the control group (P<0.05). The best corrected visual acuity (BCVA) was improved, the intraocular pressure was increased and retinal thickness was decreased after the treatment. The BCVA of patients in the observation group was significantly greater than that of patients in the control group while the intraocular pressure and retinal thickness of patients in the observation group were significantly less than those of patients in the control group (P<0.05). In conclusion, the effect of 23G surgical method in PDR patients can be improved and corresponding complications can be reduced under the assistance of OCT three-dimensional reconstruction.

Influence of systematic nursing on the recovery of IVF-ET pregnant woman after cesarean delivery

Objective To discuss about the influence of systematic nursing on the recovery of IVF-ET pregnant women after cesarean delivery. Methods The study objects were 78 IVF-ET pregnant women with cesarean delivery hospitalized from June 2013 to October 2015 in our hospital, of which 48 cases were in observation group and 30 cases were in control group randomly.Conventional nursing was adopted in control group and systematic nursing was adopted in observation group to compare the recovery condition of two groups of pregnant women after cesarean delivery. Results The postoperative uroschesis, abdominal distension, ache 48 hours after operation and other complication occurrence rate of pregnant women in observation group were lower than that of the control group.In addition, the exsufflation, effective milk secretion rate and nursing satisfaction in 24 hours were higher than control group (P<0.05). Conclusion Systematic nursing was applied to the IVF-ET pregnant women after cesarean delivery.The recovery effect after delivery is remarkable that the complication occurrence rate after delivery can be reduced effectively. Key words: Systematic nursing care; IVF-ET pregnant women; Postpartum rehabilitation

Diagnostic and therapeutic role of endoscopic retrograde pancreatography in the management of traumatic pancreatic duct injury patients: Single center experience for 34 years

BackgroundTraumatic pancreatic injuries are rare and present diagnostic and therapeutic difficulties. We evaluated the usefulness of endoscopic retrograde pancreatography and transpapillary pancreatic stent in the diagnosis and treatment of pancreatic trauma patients. MethodsWe reviewed medical records of 83 pancreas trauma patients who underwent endoscopic retrograde pancreatography for the suspicion of pancreas duct injury between January 1983 and December 2016. Patient notes, radiologic findings, laboratory investigations, operative records, and endoscopic retrograde pancreatography reports were reviewed. ResultsPre-endoscopic retrograde pancreatography abdominal computed tomography was performed in 52 patients. Twenty-seven patients of them were diagnosed with a major pancreatic duct injury by subsequent endoscopic retrograde pancreatography. Eleven major pancreatic duct injuries (40.7%) were missed by the pre-endoscopic retrograde pancreatography abdominal CT. Major pancreatic duct injury was confirmed by endoscopic retrograde pancreatography in 43 patients. These 43 major pancreatic duct injury patients were classified into the Operative (n = 21), Stent (n = 15), and Conservative (n = 7) groups according to the first treatment modality which was chosen by attending surgeon. Age, initial white blood cell count, initial serum amylase, associated injury, and major pancreatic duct injury site were similar among groups, while the rate of parenchymal leakage (Dye leakage confined to pancreatic capsule) on endoscopic retrograde pancreatography findings differed. Parenchymal leakage was most common in the Conservative group. Pancreas related mortality occurred in 1 (4.76%) Operative group, 2 (13.33%) Stent group, and 0 (0%) Conservative group. Pancreas related complication occurred in 16 (76.19%) Operative group, 10 (66.67%), Stent group and 5 (71.43%) Conservative group. There were no statistically significant differences in the occurrence rate of pancreas related complications and mortalities among three groups. ConclusionEndoscopic retrograde pancreatography helps clinicians choose a treatment modality for major pancreatic duct injury since it provides information about the precise condition of the major pancreatic duct injury. Endoscopic retrograde pancreatography with transpapillary pancreatic stenting also shows promise as a substitute for laparotomy or pancreatic resection in selected patients.

Comparative study of Mammotome minimally invasive operation and traditional surgery in treating benign breast tumor

Objective To compare the effect of ultrasound-guided Mammotome minimally invasive operation and traditional surgery in treating benign breast tumor. Methods Eighty patients with benign breast tumor admitted to People′s Hospital of Beijing Daxing District from October 2015 to April 2016 were randomly divided into group A and group B. Patients in group A accepted ultrasound-guided Mammotome minimally invasive operation (n=40), while patients in Group B accepted traditional surgery(n=40). Operation time, incision length, blood loss, patient satisfaction, postoperative pain, and the occurrence rates of complications were compared between the two groups. Results All the tumors in two groups were removed. Patients in group A had shorter operation time(10.4±1.0) min, less blood loss(4.1±0.5) ml, smaller length of incision(0.34±0.04) cm (P<0.05 or P<0.01); also had less occurrence of complication (P<0.05); and patients in group A had better patient′s satisfaction(95%) (P<0.01). Conclusions Ultrasound-guided Mammotome minimally invasive operation is helpful to shorten operation time and incision length, and reduce blood loss, also improve satisfaction. It is valuable for application and popularization in primary hospital. Key words: Breast neoplasms; Surgical procedures, minimally invasive; Comparative study; Mammotome minimally invasive operation

Foreign body aspiration in children: Focus on the impact of delayed treatment

ObjectiveThis study aims to analyze the impact of delayed treatment of foreign body aspiration (FBA) in children. Materials and methodsIn this study, we retrospectively reviewed 220 children who were diagnosed with FBA through rigid bronchoscopy from January 2010 to May 2016 in our hospital. The time elapsed between aspiration event and arrival at our hospital exceeded 24 h was considered to have a delayed treatment. The occurrence rate of complications at admission, operation time and hospitalization time were compared between the delayed treatment group and non-delayed treatment group. ResultsA total of 220 children diagnosed with FBA by rigid bronchoscopy were enrolled in this study, including 138(62.7%) boys and 82(37.3%) girls. The median age was 20 months. Only 102 (46.4%) cases came to our hospital within 24 h. The remaining 118 (53.6%) cases had a delayed treatment. The occurrence rate of complication at admission was significantly higher in the delayed treatment group than in the non-delayed treatment group (80.5% vs. 52.9%, P < 0.01). Delayed treatment group also had significantly longer operation time and hospitalization time than non-delayed treatment group (median operation time: 18min vs. 10min; median hospitalization time: 4d vs. 3d; both P < 0.01). In multivariate analysis, delayed treatment remained an independent risk factor for longer operation time (HR 2.47, 95% CI 1.13–5.44, P = 0.02) and longer hospitalization time (HR 2.19, 95% CI 1.23–3.88, P = 0.01). ConclusionDelayed treatment of FBA is not only related to higher occurrence rate of complication but also associated with longer operation and hospitalization time.

Comparison of Endoscopic Resection and Minimally Invasive Esophagectomy in Patients With Early Esophageal Cancer.

To determine whether endoscopic resection (ER) and minimally invasive esophagectomy (MIE) are safe and effective for treating squamous intraepithelial neoplasia of the esophagus. This study retrospectively analyzed a total of 99 consecutive patients with pathologically confirmed early esophageal cancer between December 2007 and 2011. ER was performed in 59 patients, whereas MIE was performed in 40 patients. We compared the 2 groups according to R0 resection rates, treatment-related complications, mean hospital stay, local recurrence rates, and 3- and 4-year overall survival. No significant differences were found in the R0 resection rates between ER and MIE (94.9% vs. 97.5%, P>0.05). The occurrence rate of minor complications in the ER group was significantly lower than that in the thoracoscopic esophagectomy group (11.8% vs. 32.5%, P>0.05). The mean operative time in the ER group was 74±23 minutes, which was significantly shorter than that in the MIE group (298±46 min). The average length of hospital stay in the ER group was significantly shorter than that in the MIE group (P<0.001). No significant differences were observed in the local recurrence rates between the 2 groups (P>0.05). Similarly, no differences were found in the 3-year survival rate (ER: 96.6%, vs. MIE: 97.5%, P>0.05) and 4-year survival rate (ER: 91.5% vs. MIE: 90%, P>0.05) between the 2 groups. ER achieves the same positive results as MIE in the treatment of early esophageal cancer and is associated with a lower complication rate, a shorter recovery time, and a similar survival rate. However, multiple ER procedures were required for several patients in this study.

Psychoanalysis and intervention effect on unstable angina pectoris patients in perioperative period

Objective The corresponding psychological care and intervention method are designed to prevent and reduce postoperative complications to occur and promote patients to get recovered by means of investigating and analyzing the anxiety condition of unstable angina pectoris patients in perioperative period. Methods A total of 348 patients diagnosed as unstable angina pectoris were selected and optional interventional therapy was implemented. By means of self-rating anxiety scale testing investigation, the patients were divided into SAS<50 scores group and SAS≥50 score group. In addition, two groups of patients were divided into two subgroups randomly, of which psychological care intervention was conducted two one group and usual care was conducted to the other group to analyze the influence of psychological care intervention on the occurrence rate of postoperative complications. Results Compared with male, SAS sores of female were higher(61.1±10.9 vs 53.1±12.8, P=0.038), and it was easy to have anxiety disorder. With regard to SAS≥50 scores patients, the occurrence rate of postoperative complications was higher than the patients of SAS 0.05). However, psychological care intervention conducted to the patients of SAS≥50 scores could significantly reduce the occurrence rate of postoperative complications(13.3% vs 37.1%, P<0.01). Conclusion The anxiety state during perioperative period of interventional therapy can significantly influence the prognosis for the unstable angina pectoris patients. Psychological care should be strengthened for the anxiety patients, which is very effective to prevent and reduce the occurrence of postoperative complications. Key words: Unstable angina pectoris; Anxiety; Psychological care

Safety and effectiveness of localized lung resection combined with neoadjuvant chemotherapy in the treatment of stage I-II non-small cell lung cancer.

This study was conducted to evaluate the safety and effectiveness of localized lung resection combined with neoadjuvant chemotherapy in the treatment of stage I–II non-small cell lung cancer (NSCLC). A total of 88 patients, who were admitted to our hospital for first diagnosis and treatment, were selected. The patients were divided into control group (n=40 cases) and observation group (n=48 cases) according to the last digit of the admission number. The control group was treated with minimally invasive localized lung resection by thoracoscope. The observation group underwent the same procedure combined with two cycles of systemic neoadjuvant chemotherapy before the surgery was adopted in the observation group. The effects of both treatments were compared. The operation time, intraoperative blood loss and postoperative drainage volume of observation group were significantly lower than those of the control group (P<0.05). The surgical resection rate and margin negative rate of observation group were higher than those of control group, while the occurrence rate of complications was lower than that of control group; results were statistically significant (P<0.05). The serum neutrophil gelatinase associated lipocalin (lipocalin-2/NGAL), matrix metalloproteinase-9 (MMP-9) and carcinoembryonic antigen (CEA) levels of two groups after the treatment were lower than those before; however, levels in the observation group exhibited a distinct decrease. The difference has statistical significance (P<0.05). The follow-up time of two groups was 3–38 months and the median time was 20.5 months. The tumor survival period of observation group was not prolonged, however, the survival rate and quality rate of life were enhanced; the difference has statistical significance (P<0.05). Localized lung resection combined with neoadjuvant chemotherapy can effectively improve the surgical effect of stage I–II NSCLC, prolong the survival period, enhance the survival rate, decrease the occurrence rate of complications and reduce the tumor related factors lipocalin-2, MMP-9 and CEA levels.

Microwave ablation is as effective as radiofrequency ablation for very-early-stage hepatocellular carcinoma

BackgroundPercutaneous radiofrequency ablation (RFA) is a first-line treatment for very-early-stage hepatocellular carcinoma (HCC), whereas the efficacy of percutaneous microwave ablation (MWA) for very-early-stage HCC remains unclear. The purpose of this study was to clarify this issue by comparing the safety and efficacy of percutaneous MWA with percutaneous RFA in treating very-early-stage HCC.MethodsClinical data of 460 patients who were diagnosed with very-early-stage HCC and treated with percutaneous MWA or RFA between January 2007 and July 2012 at the Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, in Shanghai, China were retrospectively analyzed. Of these 460 patients, 159 received RFA, 301 received MWA. Overall survival (OS), recurrence-free survival (RFS), local tumor progression (LTP), complete ablation, and complication occurrence rates were compared between the two groups, and the prognostic factors associated with survival were analyzed.ResultsNo significant differences were observed between the two groups in terms of the 1-, 3-, or 5-year OS rates (99.3%, 90.4%, and 78.3% for MWA vs. 98.7%, 86.8%, and 73.3% for RFA, respectively; P = 0.331). Furthermore, no significant differences were observed between the two groups in terms of the corresponding RFS rates (94.4%, 71.8%, and 46.9% for MWA vs. 89.9%, 67.3%, and 54.9% for RFA, respectively; P = 0.309), the LTP rates (9.6% vs. 10.1%, P = 0.883), the complete ablation rates (98.3% vs. 98.1%, P = 0.860), or the occurrence rates of major complications (0.7% vs. 0.6%, P = 0.691). By multivariate analysis, LTP, antiviral therapy, and treatment of recurrence were independent risk factors for OS (P < 0.001), and the alpha-fetoprotein level was an independent prognostic factor for RFS (P = 0.002).ConclusionsMWA is as safe and effective as RFA in treating very-early-stage HCC, supporting MWA as a first-line treatment option for this disease.

Effect of etomidate on the oxidative stress response and levels of inflammatory factors from ischemia-reperfusion injury after tibial fracture surgery

The effect of etomidate on the oxidative stress response and levels of inflammatory factors resulting from ischemia-reperfusion injury of the lower extremities during tibial fracture surgery were investigated. From December 2013 to June 2015, 60 tibial fracture patients with surgical indications for open reduction and internal fixation were selected. Patients were randomly divided into the observation group and the control group. All patients were stanched by tourniquet hemostasis. Patients in the observation group were anesthetized with etomidate (3–6 mg/kg·h) + remifentanil (0.1–0.25 µg/kg/min) administered with an injection pump to maintain intraoperative sedation and analgesia anesthesia. Patients in the control group received propofol (3–6 mg/kg·h) + remifentanil (0.1–0.25 µg/kg/min). Before surgery (T0), before surgery was completed and anesthesia was stopped (T1), 24 h after surgery (T3), 48 h after surgery (T4), and 1 week after surgery (T5), serum superoxide dismutase (SOD) activity was determined with a kit, and ELISA was used to measure the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1, and IL-6 in peripheral blood from both groups of patients. Surgery in both groups was completed smoothly. We found that serum SOD levels of patients in the observation group were significantly higher than those of the control group, while the levels of TNF-α, IL-1, and IL-6 released by neutrophils were significantly decreased after ischemia-reperfusion injury (P<0.05). Postoperative length of stay in hospital of the observation group was significantly shorter and the occurrence rate of anesthesia complications was significantly lower than in the control group (P<0.05). In conclusion, during surgery for lower limb fracture, the use of etomidate for maintaining sedation can effectively maintain serum SOD activity and inhibit the release of inflammatory factors after ischemia-reperfusion injury of the fracture, to reduce the occurrence rate of anesthesia complications after surgery.

The Application and Effect of the Nursing Protocol of Pediatric Peripheral Intravenous Infusion

Purpose: The aim of this study was to compare the effect of training and implementation of a pediatric peripheral intravenous infusion protocol on the nurses’ performance and infusion complication rate. Methods: A quasi-experimental study using a posttest comparison of a one group pretest-time series design was utilized. This method was developed to measure nursing knowledge and performance based on a pediatric peripheral intravenous infusion protocol. To calculate the occurrence rate of complications, the number of complications were divided into the number of intravenous insertions. Results: It was shown that the training developed by the study team in 2015 contributed to nurses’ increased knowledge, as well as improved job performance. Furthermore, the implementation of the protocol revealed that the number of peripheral intravenous insertions, an invasive procedure, decreased. Additionally, the nursing workload related to pediatric intravenous infusions was reduced. Conclusion: This protocol may contribute to the improved scientific quality and efficiency of nursing management of peripheral intravenous infusions.

Evaluation of safety and efficacy of elective PCI in patients with cardiac insufficiency

We analyzed the safety and the efficacy of the treatment with elective percutaneous coronary intervention (PCI) in patients with coronary heart disease complicated with cardiac insufficiency. We enrolled 217 patients diagnosed with chronic ischemic heart disease complicated with cardiac failure. According to the type of treatment they received, patients were divided into 3 groups: i) The conservative treatment group with 60 patients (they received standard medication); ii) the early PCI group with 82 cases (their condition was stabilized, surgical risk was assessed and PCI was taken as early as possible); and iii) the advanced PCI group with 75 cases (ischemic myocardium was corrected and then elective PCI was applied and for aggravated myocardial ischemia cases, PCI was applied after assessing the risk of surgery). Follow-up visits were set for approximately 3 years and clinical outcomes were compared. Our results showed that the survival time in the early PCI group was significantly prolonged and the survival rate was considerably increased during 3 years. Left ventricular ejection fraction in the early PCI group markedly increased and left ventricular end-diastolic diameter and pro-BNP level decreased significantly. The occurrence rates of perioperative complications in the early PCI group and major adverse cardiac events (MACE) during the follow-up period were significantly reduced. Quality of life scores in the early PCI group markedly improved. We concluded that in patients with coronary heart disease complicated with cardiac insufficiency, early PCI treatment was safe and effective.

Application of placing biological patches by the rolling curtain method in laparoscope hernia neoplasty

Objective To comment on the feasibility and advantage of using the rolling curtain method to place biological hernia patches in abdominal peritoneum hernia neoplasty. Methods Sixty cases undergoing laparoscopic abdominal peritoneum hernia neoplasty with biological patches from January 2013-January 2014 were divided into control group and observation group using random number table method. The patients in the observation group were given rolling curtain method to place biological patch, and those in the control group were subjected to the traditional tiling method to place hernia patch. The operation time, hospital fees, and occurrence rate of surgical complications were comparatively analyzed in the two groups. Results All 60 cases of laparoscope Abdominal peritoneum hernia neoplasty were successful. None were converted to open operations. Total operation time in the observation group and control group was (55.0±4.6) min and (70.0±7.8) min, respectively (t=2.48, P<0.05). The hospital fees in the observation group and control group were (22 380±432) yuan RMB and (24 340±624) yuan RMB, respectively (t=2.06, P<0.05). The incidence of surgical complications in the observation group and control group was 3.33% (1/30) and 16.70% (5/30), respectively (χ2=5.93, P<0.05). Conclusion The rolling curtain method can be applied to laparoscopic abdominal peritoneum hernia neoplasty with biological patches. Compared with the traditional method, the rolling curtain method has apparent advantages, and fewer complications during and after the operation, thus is recommended. Key words: Biological patch; Laparoscope; Hernia neoplasty

Early Enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury: Effects on Immune Function, Nutritional Status and Outcomes.

Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN) with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patients with severe traumatic brain injury (STBI). Methods A prospective randomized control trial was carried out from January 2009 to May 2012 in Neurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow Coma Scale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were admi- nistrated EN, PN or EN+PN treatments respectively. The indexes of nutritional status, immune function, complications and clinical outcomes were examined and compared statistically. Results There were 120 patients enrolled in the study, with 40 pationts in each group. In EN+PN group, T lymthocyte subsets CD3+%, CD4+%, ratio of CD3+/CD25+, ratio of CD4+/CD8+, the plasma levels of IgA, IgM, and IgG at 20 days after nutritional treatment were significantly increased compared to the baseline(t=4.32-30.00, P<0.01), and they were significantly higher than those of PN group (t=2.44-14.70; P<0.05,or P<0.01) with exception of CD4+/CD8+, higher than those of EN group (t=2.49-13.31, P<0.05, or P<0.01) with exceptions of CD3+/CD25+, CD4+/CD8+, IgG and IgM. For the nutritional status, the serum total protein, albumin, prealbumin and hemoglobin were significantly higher in the EN (t=5.87-11.91; P<0.01) and EN+PN groups (t=6.12-13.12; P<0.01) than those in PN group after nutrition treatment. The serum prealbumin was higher in EN+PN group than that in EN group (t=2.08; P<0.05). Compared to the PN group, the complication occurrence rates of EN+PN group were significantly lower in stress ulcer (22.5% vs. 47.5%; χ2= 8.24, P<0.01), intracranial infection (12.5% vs 32.5%;χ2= 6.88, P<0.01) and pyemia (25.0% vs. 47.5%; χ2= 6.57, P<0.05). Compared to the EN group, the complication occurrence rates of EN+PN group were significantly lower in aspirated pneumonia (27.5% vs. 50.0%; χ2= 6.39, P<0.05), hypoproteinemia (17.5% vs. 55.0%; χ2= 18.26, P<0.01) and diarrhea (20.0% vs. 60.0%; χ2= 20.00, P<0.01). The EN+PN group also had significant less length of stay in NICU (t=2.51, 4.82; P<0.05, P<0.01), number of patients receiving assisted mechanical ventilation (χ2= 6.08, 12.88; P<0.05, P<0.01) and its durations (t=3.41, 9.08; P<0.05, P<0.01), and the death rate (χ2=7.50, 16.37; P<0.05, P<0.01) than those of EN or PN group. Conclusion Early EN+PN treatment could promote the recovery of the immune function, enhance nutritional status, decrease complications and improve the clinical outcomes in patients with severe traumatic brain injury.