Postoperative Adverse Reactions Research Articles

The Effect of Nursing Intervention on Patients with Inguinal Hernia and Its Influence on Self-Management Ability.

Objective To objectively evaluate the nursing quality of patients with inguinal hernia from the aspects of postoperative pain, self-discipline, and complications, the application of medical data analysis and nursing intervention in patients with inguinal hernia was discussed. Methods A total of 86 patients with inguinal hernia were selected, and the time distribution was from September 2020 to March 2021. The patients were divided into two groups: in the control group, there were 43 cases, 28 males and 15 females. There were 43 cases in the observation group, 25 males and 18 females. All selected subjects must sign the informed consent form and have the right to know the research content. The patients were diagnosed by abdominal ultrasound, and the demographic data and basic clinical data were recorded. Results A total of 86 patients were divided into two groups in this study, of which 43 patients used a routine nursing path as the control group and the other 43 patients added medical data analysis and nursing intervention as the observation group on the basis of the routine nursing path. The postoperative pain, self-discipline, complications, and patient satisfaction were compared, and the patients' satisfaction in the experimental group was significantly higher than that in the control group, while serum swelling and urine retention were significantly lower than those in the control group (p < 0.05). Conclusion According to the analysis of the routine nursing path and medical data, nursing intervention patients have more stable emotions and less postoperative pain. They can get out of bed early, reduce the occurrence of other complications, and improve the overall curative effect. Systematic nursing intervention can reduce the incidence of postoperative adverse reactions and complications. It is one of the ideal adjuvant treatments for inguinal hernia patients.

Efficacy and safety of sevoflurane vs propofol in combination with remifentanil for anesthesia maintenance during craniotomy: A meta-analysis.

Background:The purpose of this study was to evaluate the efficacy and safety of sevoflurane-remifentanil (SR) vs propofol-remifentanil (PR) as inhalation anesthesia or total intravenous anesthesia in patients undergoing craniotomy, respectively.Methods:Electronic databases included PubMed, ScienceDirect, Embase, Cochrane library, CNKI, and Wanfang data were searched using suitable search items. Randomized clinical controlled trials comparing the combination of SR and PR as anesthetics for neurosurgery were included. The outcomes included wake-up time, spontaneous respiration time, extubation time, and safety.Results:Seventeen studies were included in this meta-analysis. There were no statistically significant differences in wake-up time (P = .25, standardized mean difference (SMD) = 0.29, 95% CI –0.20 to 0.77), extubation time (P = .1, SMD = 0.52, 95% CI –0.11 to 1.14) and spontaneous respiration time (P = .58, SMD = 0.43, 95% CI –1.07 to 1.93) when patients with SF and PF for anesthesia maintenance. Moreover, the changes of hemodynamic parameters are similar between the 2 groups. During anesthesia maintenance, SF could significantly increase the incidence of hypotension and brain edema than PF (P = .02, SMD = 1.68, 95% CI 1.07 to 2.62; P < .0001, SMD = 3.37, 95% CI 1.86 to 6.12), PF markedly promoted the incidence of hypertension (P = .001, SMD = 0.55, 95% CI 0.39 to 0.79). The postoperative adverse reactions were similar between the 2 groups (P > .05), but the incidence of postoperative nausea and vomiting proved to be higher in SF group (P < .0001, SMD = 2.12, 95% CI 1.47 to 3.07).Conclusions:SR and PR as anesthetics in patients underwent craniotomy had similar effects, but PR was superior to SR in terms of safety of intraoperation and postoperation.

Ultrasound Image Features under Decomposition Algorithm to Analyze the Nursing Intervention on Patients with Colon Polyps Undergoing Endoscopic Resection.

Based on the ultrasonic imaging and endoscopic resection of the intelligent segmentation algorithm, this study is aimed at exploring whether nursing intervention can promote the good recovery of patients with colon polyps, hoping to find a new method for clinical treatment of the colon polyps. Patients with colon polyps were divided into an experimental group (fine nursing) and a control group (general nursing). The colonoscopy polyp ultrasound image was preprocessing to select the seed points and background points. The random walk decomposition algorithm was applied to calculate the probability of each marked point, and then, the marked image was outputted. The accuracy of the intelligent segmentation algorithm was 81%. The incidence of complications in the experimental group was 4.83%, which was lower than 16.66% in the control group, and the difference was statistically obvious (P < 0.05). Perioperative refined nursing intervention for colon polyp patients undergoing endoscopic electrosurgical resection can decrease postoperative adverse reactions; reduce postoperative mucosal perforation, blood in the stool, abdominal pain, and small bleeding; lower the incidence of postoperative complications; and allow patients to recover quickly, enhancing the life comfort of patient.

Clinical evaluation of the rapid recovery of patients who underwent video-assisted thoracoscopic lung surgery under non-intubated anesthesia.

BackgroundNon-intubated anesthesia thoracoscopic surgery is an evolving form of minimally invasive thoracic surgery. It has had encouraging results in the treatment of lung cancer, and the current concept of enhanced recovery after surgery has become indispensable to surgical treatment. Our center retrospectively evaluated the clinical effect of rapid postoperative rehabilitation in patients who underwent thoracoscopic lung surgery under non-intubated anesthesia.MethodsThe clinical data of 192 patients undergoing video-assisted thoracoscopic surgery (VATS) at the Department of Thoracic Surgery of The First People’s Hospital of Yunnan Province were retrospectively analyzed. Among them, 75 received double-lumen endotracheal intubation anesthesia, and 117 received a laryngeal mask instead of endotracheal intubated anesthesia. Comparing the intra-and post-operative indicators difference of these 2 groups.ResultsThere were no significant differences in the postoperative complications, length of hospital stay, hemoglobin counts and platelet count 24 h after surgery between the non-intubated anesthesia and intubated anesthesia groups (P>0.05). In terms of the postoperative rehabilitation indicators of the VATS patients, the non-intubated anesthesia group had an earlier recovery in terms of water (food) intake, out-of-bed activity, and defecation (exhaust) times (P<0.001), less postoperative complications and adverse throat reactions (P<0.05), and higher levels of satisfaction (P<0.05) than the intubated anesthesia group. Compared to the intubated anesthesia group, the non-intubated anesthesia group had fewer changes of white blood cell counts, neutrophil percentages and lymphocytes percentages 24 h postoperatively (9.25×109 vs. 7.67×109, P=0.045; 7.06 vs. 5.53, P=0.039; 1.45 vs. 1.27, P=0.017), significant reduction pleural drainage after restoring oral intake in postoperative 24 and 48 h (198.43 vs. 131.07 and 114.04 vs. 57.47 mL, P<0.001), shorter postoperative thoracic tube drainage times (3.73 vs. 3.13 d, P<0.001). Notably, there was no difference between the smoking history and previous medical history of the patients in the 2 groups.ConclusionsCompared to intubation by general anesthesia, non-intubated thoracoscopic anesthesia is a safe and effective option. Patients who undergo non-intubated thoracoscopic lung surgery have a rapid recovery after surgery. Thus, it is worthy of promotion in clinical surgery settings.

Effect of Different Concentrations of Esmolol on Perioperative Hemodynamics and Analgesia in Patients Undergoing Colectomy: A Prospective, Randomized Controlled Study.

PurposeThe aim of this study was to investigate the efficacy of esmolol on intraoperative hemodynamic and perioperative analgesic management.MethodsTotally, 125 patients undergoing colectomy were randomly divided into three groups. Group S (saline group) was administered 0.75 mL/kg/h of normal saline for 5 min before anesthesia induction and maintenance of 0.25 mL/kg/h; Group E1 and Group E2 were administered 0.5 mg/kg and 1.0 mg/kg esmolol for 5 min before anesthesia induction, and maintained of 0.5 mg/kg/h and 2.0 mg/kg/h, respectively. Several parameters including indexes of hemodynamics variation (primary outcome), intra- and postoperative analgesic usage, and pain score were measured.ResultsGroup E1 and Group E2 had significantly lower intubation response than Group S (P = 0.007, P = 0.001), and extubation response of Group E2 was significantly lower than Group S (P = 0.007). The opioid consumption in Group E1 and Group E2 was significantly lower than in Group S intraoperatively (P = 0.020 and 0.007). The incidence of postoperative adverse reactions among the three groups was not statistically significant (P = 0.368 and 0.772).ConclusionEsmolol 0.5 mg/kg and 1.0 mg/kg infusion before intubation both can effectively inhibit the intubation response, while only maintenance with 2.0 mg/kg/h of esmolol can reduce the incidence of extubation response. At the same time, esmolol can decrease intraoperative opioid requirement without increasing the risk of adverse reactions.Trial RegistrationChiCTR1900024538 and the date of registration was July 15, 2019 at http://www.chictr.org.cn.

Efficacy of Different Preemptive Analgesia on Postoperative Analgesia, Oxidative Stress, and Inflammatory Response after Gynecological Laparoscopic Surgery.

Objective To observe and compare the analgesic effects of oxycodone, pentazocine, and ketorolac tromethamine pre-emptive analgesia on gynecological laparoscopic patients after operation and the effects on oxidative stress and inflammatory reaction. Methods A total of 64 patients who underwent elective gynecological laparoscopic surgery in Yiwu Central Hospital from June 2019 to December 2020 were randomly divided into four groups (n = 16). Before anesthesia induction, oxycodone (group A), pentazocine (group B), ketorolac tromethamine (group C), and normal saline (group D) were, respectively, administered. Patients' mean arterial pressure (MAP) and heart rate (HR) changes, visual analogue scale (VAS), Bruggemann comfort scale (BCS), serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), blood glucose (CLU), serum cortisol level, postoperative adverse reactions, and additional analgesia were recorded at each time point. Results The MAP levels of T2 (immediate intubation), T3 (immediate catheter removal), and T4 (5 min after catheter removal) in the four groups were higher than those of T1 (quiescent state), and the HR levels T2, T3, and T4 were lower than those of T1 (P < 0.05). The MAP and HR levels of T2, T3, and T4 in patients of groups A, B, and C were lower than those of group D in the same period (P < 0.05). The VAS and BCS scores of groups A, B, and C at 1, 6, 12, and 24 h after operation were better than those of group D at the same time, and the scores of group A at 1 h and 6 h after operation were better than those of groups B and C at the same time (P < 0.05). The levels of serum TNF-α, IL-6, and CRP in the four groups of patients at 6, 12, and 24 h after operation were higher than those before operation, but those in groups A, B, and C were lower than those in group D, and those in group A were higher than those in groups B and C at 12 h and 24 h after operation (P < 0.05). The CLU and serum cortisol levels in the four groups were significantly higher at 6, 12, and 24 h after operation, but those in groups A, B, and C were lower than those in group D, and those in group A were lower than those in groups B and C at 6 and 12 h after operation (P < 0.05). There was no significant difference in the incidence of adverse reactions within 24 h between the four groups (P > 0.05). The incidence of additional analgesia in groups A, B, and C was lower than that in group D (P < 0.05). Conclusion Oxycodone, pentazocine, and ketorolac tromethamine are effective and safe in inhibiting postoperative pain and the generation of inflammatory factors and relieving inflammatory state in gynecological laparoscopic pre-emptive analgesia. Oxycodone has better postoperative analgesic effect because it can effectively alleviate stress reaction.

Bronchial Artery Chemoembolization for Hemoptysis in Advanced Primary Lung Cancer

BackgroundTo evaluate the safety and effectiveness of bronchial arterial infusion chemoembolization (BAICE) for lung cancer with hemoptysis. Patients and MethodsRetrospectively analyze clinical data of patients undergoing BAICE for the treatment of lung cancer with hemoptysis, evaluate the clinical efficacy of this approach, observe postoperative adverse reactions, and analyze hemoptysis-free survival (HFS) and overall survival (OS). ResultsAll 187 patients underwent BAICE with technical success rate of 100%, clinical success rate of 86.6%, clinical failure rate of 13.4%. After BAICE, the tumor curative effect was evaluated as complete remission in 56 cases, partial remission in 82 cases, stable disease in 26 cases, and progressive disease in 6 cases. The objective response rate was 73.8%, and the disease control rate was 87.7%. Median HFS of the 154 clinically successful cases was 10.5 months (95% confidence interval [CI]: 8.11-11.89). The degree of hemoptysis (massive hemoptysis hazard ratio [HR] = 5.9, 95% CI: 3.43-10.16, P = .00) and cavitary lung mass (HR = 2.39, 95% CI: 1.44-3.99, P = .001), were significantly related to a reduction in HFS after BAICE. The 6-month and 12-month survival rates were 66.5% and 45.6%, respectively. The median OS of clinically successful cases was 13.0 months (95% CI: 11.22-14.77). The median OS of 16 clinically failed cases was 2.0 months (95% CI: 0.41-2.45) (P < .001). All adverse events were grade 1. ConclusionBAICE for advanced lung cancer with hemoptysis is safe, effective, and tolerable.

Effect of Meticulous Nursing on Negative Situation, Clinical Symptom and Quality of Life of Patients Undergoing Benign Prostatic Hyperplasia Surgery

To explore the effect of meticulous nursing on postoperative recovery and adverse reactions of patients with benign prostatic hyperplasia (BPH) surgery. From February 2018 to February 2019, 104 patients with BPH who were diagnosed and treated in our hospital were selected. Forty-eight patients with BPH who received routine nursing were included in the routine nursing group (RNG). A total of 56 patients undergoing BPH surgery were included in the meticulous nursing group (MNG), who received meticulous nursing intervention on the basis of routine nursing. The scores of self-rating depression scale (BDI), self-rating anxiety scale (BAI), Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD), quality of life, complications and nursing satisfaction were compared between the two groups after nursing. After nursing, the levels of BDI, BAI, HAMA and HAMD in both groups were obviously lower than those before nursing, and the differences were statistically significant (P&lt;0.001). After nursing, the levels of HAMA and HAMD in MNG were obviously lower than those in RNG, and the differences were statistically significant (P&lt;0.001). The nursing safety, disinfection and isolation, management of instruments and equipment, preparation of surgical instruments, standardization of nursing operation and nursing staff cooperation scores in MNG were obviously better than those in RNG (P&lt;0.001). The total nursing satisfaction of patients in MNG was obviously higher than that in RNG, and the difference was statistically significant (P&lt;0.05). Compared with the two groups, the QOL-C30 scale scores of physical health, mental health, material life and social function in MNG were obviously higher than those in RNG, and the differences were statistically significant (P&lt;0.001). After nursing intervention, the incidence of complications in MNG was obviously lower than that in RNG (P&lt;0.05). On the basis of routine nursing, meticulous nursing intervention can better improve the emotion regulation and quality of life of patients undergoing BPH surgery, and reduce their incidence of postoperative complications to some extent.

The Effect of Different Surgical Approaches of Ultrasound-Guided Quadratus Lumborum Block on the Analgesic Effect in Cesarean Section

Objective To study the effect of different surgical approaches of ultrasound-guided quadratus lumborum block on the analgesic effect in cesarean section. Methods 150 parturients underwent elective caesarean section in our hospital from February 2017 to February 2020 were enrolled in this study. They were divided into observation group and control group according to the method of random number table, with 75 cases in each group. In control group, anterior QLB was used, while in observation group, posterior QLB was used. The operation process was performed by the same anesthesiologist. If the injection situation was not ideal, the position of needle tip was timely adjusted. Both groups were given sufentanil 100 HQ/kg (diluted with 100 mL normal saline) and a single addition of morphine 50 mg (diluted with 100 mL normal saline) for self-controlled analgesia after operation. The postoperative time to first water intake, the time to first discharge from bed, hospital stay and satisfaction degree of labor pain were compared between the two groups. The numerical pain score (NRS) and visual analogue scale (VAS) scores of rest and movement at different time after operation were compared. The dosage of sufentanil and morphine in perioperative period and the occurrence of postoperative adverse reactions were compared between the two groups. Results The time to first water intake, the time to first discharge from bed and hospital stay in the observation group were significantly shorter than those in the control group (P &lt; 0.05), and the satisfaction score of analgesia in the observation group was significantly higher than that in the control group (P &lt; 0.05). The NRS score of observation group at TO, 1, 2, 3 and 4 after operation was significantly lower than that of control group (P &lt; 0.05). There was no significant difference in VAS score of rest and movement at 4 and 8 h after operation between the two groups (P &gt; 0.05); the VAS score of rest and movement at 12 and 24 h after operation in observation group was significantly lower than that in control group (P &lt; 0.05). The amount of sufentanil and morphine used in the perioperative period in the observation group was significantly less than that in the control group (P &lt; 0.05). The total incidence rate of adverse reactions in observation group was not significantly different from that in control group (P &gt; 0.05). Conclusion Both anterior and posterior QLB can provide analgesia after cesarean section, but posterior QLB can better relieve the postoperative pain of parturients, which is worth popularizing in clinic.

Clinical Efficacy of Immediate Rehabilitation Training after Coronary Artery Intervention in Patients with AMI

This paper investigates the effect of rehabilitation training on the clinical outcome and prognosis of patients with acute myocardial infarction after coronary artery intervention. There was no significant difference in daily living ability score and left ventricular ejection fraction between group A before intervention (P&gt;0.05). The score of daily living ability of group A was (76.58±3.27) significantly higher than that of group B after intervention (73.7). ±3.4) (P&lt;0.05); left ventricular ejection fraction after intervention (55.75±4.4) was significantly higher than that of group B (52.41 ±4.19) (P&lt;0.05); total satisfaction rate of patients in group A (93.02%) was significantly higher In group B (69.77%), the difference between the groups was statistically significant (P&lt;0.05); the total incidence of adverse reactions and mortality in group A (11.63%, 2.33%) was significantly lower than that in group B (53.49%, 16.28%).), the difference was statistically significant (P &lt; 0.05). In patients with acute myocardial infarction, after interventional coronary artery intervention, immediate intervention with rehabilitation training can improve left ventricular ejection fraction, improve daily living ability and nursing satisfaction, and reduce postoperative adverse reactions and death. Medical staff should be used reasonably in the clinic according to the actual situation of the patient.

Effects of Combined Epidural Anesthesia and General Anesthesia on Cognitive Function and Stress Responses of Elderly Patients Undergoing Liver Cancer Surgery.

This study aimed at exploring the effects of combined epidural anesthesia and general anesthesia on the cognitive function and stress responses of elderly patients undergoing liver cancer surgery. One hundred and fifteen elderly patients were enrolled as research subjects. They were admitted to our hospital and underwent liver cancer surgery from August 2017 to May 2019. Fifty five cases were treated with general anesthesia (GA) (GA group), while the other sixty cases were treated with combined epidural anesthesia and general anesthesia (joint group). Scoring standards of Mini-Mental State Examination (MMSE) were used to evaluate the patients before and after operation. Their operating time, total fluid input (TFI), spontaneous breathing recovery time (SBRT), preoperative and postoperative indices of stress responses (epinephrine (EPI), cortisol (Cor), and norepinephrine (NE)), and postoperative adverse reactions were observed. There were statistically significant differences between the two groups with respect to anesthesia time, TFI, postoperative SBRT, and postoperative directional recovery time (DRT) (cP < 0.05). There was no difference in operating time, total fluid loss (TFL), and hospitalization time (P > 0.05). After operation, patients in both groups experienced a cognitive decline of different degrees and the MMSE scores decreased. There was no significant difference in the score between the two groups before operation and 3 days and 7 days after operation (P > 0.05). The score was significantly better in the joint group than that in the GA group at 6 hours and 1 day after operation (P < 0.05). There were no significant differences in levels of EPI, Cor, and NE between the two groups before operation (P > 0.05), but there were significant differences after operation. The total incidence of postoperative adverse reactions was 11.67% in the joint group and 25.45% in the GA group. In conclusion, combined epidural anesthesia and general anesthesia can significantly reduce postoperative cognitive dysfunction and inhibit postoperative stress responses in elderly patients undergoing liver cancer surgery. It has good application value in clinical practice.

Application of Gold Nanoparticles in Magnetic Resonance Imaging for Targeted Diagnosis and Treatment of Breast Cancer

This study aimed to explore the application of super paramagnetic gold magnetic nanoparticles (Au-M-NPs) in the magnetic resonance imaging (MRI) images for targeted diagnosis and treatment of breast cancer. The reducibility of ethylene glycol to ferric chloride (FeCl3) was adopted to synthesize the Au-M-NPs by solvothermal method by taking acetic acid as the base source and trisodium citrate as the stabilizer. Besides, the synthesized Au-M-NPs were applied in the MRI images for targeted therapy of breast cancer. Patients from a blank group (group A), a control group (group B), and an experimental group (group C) received the traditional clinical diagnosis treatment, MRI diagnosis, and Au-M-NPs targeted therapy with MRI in turn. The results showed that the prepared Au-M-NPs were featured with small particle size and good dispersibility, and were monodispersive after surface modification. The intraoperative blood loss of patients from group A (115.3±9.33 mL) and group B (94.6±9.72 mL) was obviously higher than the loss of group C (68.4±8.7 mL) (P &lt; 0.05). The drainage volume of patients from group B (162.4±12.3 mL) and group C (131.9±11.8 mL) decreased sharply after surgery compared with group A (193.7±11.8 mL), and that in group C was the lowest (P &lt; 0.05). The proportion of local recurrence in patients from group B (12.3%) and group C (6.4%) dropped steeply in contrast to the proportion of group A (13.2%) (P &lt; 0.05). The proportion of tumor metastasis in patients from group B (11.2%) and group C (8.4%) was greatly lower than that of group A (14.8%) (P &lt; 0.05). In conclusion, the application of Au-M-NPs in the diagnosis and treatment of breast cancer with MRI could effectively reduce the incidence of intraoperative and postoperative adverse reactions.

Meta-analysis and systematic review of electronic bronchoscopy in refractory pneumonia.

A systematic review and meta-analysis were performed to explore the adoption value of electronic bronchoscopy (EBS) in the diagnosis and treatment of refractory pneumonia and to provide a theoretical basis for the clinical bronchoscopy treatment of patients. Randomized controlled trials of treatment-resistant pneumonia searched on PubMed, Embase, and other websites before December 31, 2020 were collected. Literature was selected by inclusion and exclusion criteria. Bias risk was assessed using Cochrane intervention system Review manual 5.0.2 and Review Manager 5.3. A total of 6 articles meeting the requirements were included, comprising 796 participants. The results of meta-analysis showed that the clinical efficacy [odds ratio (OR) =3.8; 95% confidence interval (CI): 1.11-12.99; Z=2.13; P =0.03] and white blood cell counts [mean difference (MD) =0.55; 95% CI: -0.57 to 1.67; Z=0.96; P=0.34] of patients both increased. The mortality rate (OR =0.7; 95% CI: 0.3-1.63; Z=0.82; P=0.41), the incidence of infection (OR =0.84; 95% CI: 0.5-1.39; Z=0.69; P=0.49), ICU hospitalization days (OR =0.59; 95% CI: 0.36-0.98; Z=2.04; P=0.04), days of antibiotic use (OR =0.39; 95% CI: 0.18-0.84; Z=2.41; P=0.02), body temperature (MD =-0.2; 95% CI: -0.24 to 0.16; Z=9.5; P<0.0001), and the PaO2:FIO2 ratio (MD =-9.96; 95% CI: -13.31 to -6.61; Z=5.83; P<0.0001) of patients in the experimental group were lower than those of the control group. Differences in white blood cell count, mortality rate, and incidence of infection of patients in the experimental group were not statistically significant compared with those in the control group. EBS adopted in the diagnosis and treatment of refractory pneumonia can reduce the occurrence of postoperative adverse reactions, reduce the infection rate, and effectively improve the clinical symptoms. It is therefore suitable for the treatment of this disease.

Effect of dexmedetomidine on hemodynamics in patients undergoing hysterectomy: a meta-analysis and systematic review.

ObjectiveWe conducted a meta-analysis and systematic review to evaluate the effects of dexmedetomidine on the hemodynamics of patients undergoing hysterectomy.MethodsWe searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases for clinical randomized controlled trials (RCTs) that allowed direct or indirect comparisons of hemodynamic indicators. We also searched nine English-language databases up to April 2021 to identify relevant research. The Cochrane risk-of-bias tool for RCTs was applied to assess the methodological quality of the eligible studies. The meta-analysis was conducted using RevMan 5.4 software.ResultsNine trials were included in this systematic review. The effect of dexmedetomidine on heart rate during surgery was significantly smaller than that of other sedatives. Intraoperative systolic and diastolic blood pressure and mean arterial pressure were more stable in the dexmedetomidine group compared with the control group. The postoperative modified Observer’s Assessment of Alertness Score was also better in the dexmedetomidine compared with the control group.ConclusionsDexmedetomidine increases hemodynamic stability in patients undergoing hysterectomy, reduces the cardiovascular stress response during surgery, and effectively prevents postoperative adverse reactions, with good safety.

Effect of warm-needle moxibustion intervention on immune function and intestinal flora in patients after colorectal cancer radical operation

To explore the effect of warm-needle moxibustion (WNM) on the levels of T cell subgroups and serum inflammatory factors, intestinal microecological balance and postoperative adverse reactions in patients with colorectal cancer. Eighty-four patients who underwent elective radical resection of colorectal cancer were randomly and equally divided into control (medication) group (23 men and 19 women) and WNM group (24 men and 18 women). Patients of the control group received conventional medication treatment (such as postoperative anti-infection and fluid supplementation), and those of the WNM group received conventional medication plus WNM stimulation (the acupuncture needle handle warmed by ignited moxa stick) of bilateral Zusanli(ST36), Sanyinjiao(SP6), Yinlingquan(SP9), Shangjuxu(ST37), and Zhaohai(KI6). The acupuncture needles were retained for 45 minutes every time, starting on the first day after surgery, once a day for 15 days. The number of T cell subsets (CD3+, CD4+, CD8+) positive cells was counted under fluorescence microscope, and the contents of serum tumor necrosis factor α(TNF-α) and interleukin-6 (IL-6) were detected by using ELISA, and the level of C-reactive protein (CRP) was detected by using immunoturbidimetry. The levels (logarithm of colony-forming units per gram of wet fecal weight) of Bifidobacterium, Lactobacillus, Escherichia coli and Enterococcus were determined. The adverse reactions (leukocyte decline, nausea and vomiting, peripheral phlebitis, cold stimulation sensitivity) were recorded after surgery. Before treatment, there were no significant differences between the two groups in the number of T cell subgroups, TNF-α and IL-6 contents, and intestinal flora numbers (P>0.05). After the treatment, self-comparison showed that the numbers of CD3+ and CD4+ positive cells, the ratio of CD4+/CD8+ and the intestinal Bifidobacterium and Lactobacillus levels in the WNM group were significantly increased (P<0.05), whereas the number of CD8+positive cells, intestinal Escherichia coli and Enterococcus levels in the WNM group, and the levels of TNF-α, IL-6 and CRP in both groups were obviously decreased in comparison with their own pretreatment (P<0.05), but no significant changes were found in the levels of CD3+ and CD4+ positive cells, CD4+/CD8+ and intestinal Bifidobacterium, Lactobacillus, Escherichia coli and Enterococcus in the control group (P>0.05). Comparison between two groups displayed that after the treatment, the numbers of CD3+ and CD4+ positive cells, the ratio of CD4+/CD8+, as well as the levels of Bifidobacterium and Lactobacillus were significantly higher in the WNM group than in the control group (P<0.05), whereas the number of CD8+ positive cells， TNF-a, IL-6 and CRP, and the levels of Escherichia coli and Enterococcus were obviously lower in the WNM group than in the control group (P<0.05). The incidence of adverse reactions including leukopenia, nausea and vomiting, peripheral phlebitis, and sensitivity to cold stimulation in the WNM group were markedly lower than those of the control group (P<0.05). WNM intervention can significantly improve the immune function, reduce the level of inflammatory factors, regulate the level of beneficial intestinal flora, and also reduce the incidence of postoperative adverse reactions in patients experiencing radical resection of colorectal cancer.

Preoperative video distraction alleviates separation anxiety and improves induction compliance of preschool children: a randomized controlled clinical trial

Objective: To explore the effect of video distraction on preoperative separation anxiety and induction compliance of preschool children receiving strabismus surgery under general anesthesia. Methods: In this prospective trial, 80 children aged 3 to 6 years scheduled for strabismus surgery under inhalation anesthesia were randomly allocated to one of two groups, a control group and a video distraction group, with 40 cases in each group. Children in the video distraction group continuously watched videos from waiting in the holding area, separating with parents, entering the operating room and induction of anesthesia, while children in the control group didn't watch videos during the same process. The modified Yale Preoperative Anxiety Scale (mYPAS) of children were recorded upon arriving at the holding area(T1)and separating with parents(T2). Induction Compliance Checklist (ICC) score was recorded when the anesthesia induction was performed. The emergence time, the occurrence rate of adverse events in post-anesthesia care unit (PACU) including nausea and vomiting, laryngospasm, severe cough, hypoxemia and sinus bradycardia, incidence of postoperative adverse reactions such as pain, dizziness, nausea and vomiting and lethargy, the parents' satisfaction of anesthesia were also assessed. Results: There were no significant difference in mYPAS score and the proportion of mYPAS score>30 between 2 groups at T1 (all P>0.05). At T2, the mYPAS score and the proportion of mYPAS score>30 in video distraction group were (34.41±13.23) and 52.50%, which were lower than those in control group (50.64±20.96, 87.50%) with statistically significant difference (all P<0.05). The ICC score of video distraction group was lower than that of the control group, which was (1.83±2.26) vs (4.03±2.99), and the difference was statistically significant (P<0.05). The proportion of children with ICC score=0 in video distraction group was 37.50%, which was higher than that in the control group (12.50%), while the proportion of children with ICC score=4-10 was lower than that of the control group, which was 17.50% vs 45.00%, and the difference was statistically significant (P<0.05). No significant intergroup differences were observed in emergence time, incidence of adverse events in PACU, and incidence of postoperative adverse reactions (P>0.05). The parents' satisfaction of anesthesia in the video distraction group was (9.23±0.89), which was higher than that in the control group (8.63±1.23), with statistically significant (P<0.05). Conclusion: Preoperative video distraction alleviates separation anxiety, improves induction compliance of preschool children receiving strabismus surgery under general anesthesia, and increases the parents' satisfaction of anesthesia.

Effect of auricular point sticking therapy on perioperative pain in patients with partial lung resection

To observe the analgesic effect of auricular point sticking therapy during the perioperative stage in the patients with partial lung resection. A total of 92 patients with partial lung resection were randomized into an auricular point group (31 cases, 1 case dropped off), the sham-auricular point group (30 cases) and a medication group (31 cases, 1 case dropped off). The routine medication for analgesia was provided in all of the three groups. In the auricular point group, 1 day before operation, the auricular point sticking therapy was applied at shenmen (TF4), sympathetic (AH6a), subcortex (AT4), brain stem (AT3,4i), anterior ear lobe (LO4), chest (AH10) and lung (CO14), retained till the third day after operation. In the sham-auricular point group, the auricular adhesive tape without semen vaccariae was used at the same points as the auricular point group. Separately, the scores of visual analogue scale (VAS) in 8, 16, 24, 48 h and 72 h after operation, the time for obtaining the mean of the postoperative VAS score<3 points, the scores of hospital anxiety and depression scale (HAD) in 8, 72 h after operation and the plasma concentration of β-endorphin in 24, 48 h after operation, as well as the adverse reactions after operation were recorded in the patients of each group. In 8, 16, 24, 48 h and 72 h after operation, VAS scores in the auricular point group were lower than those in the sham-auricular point group and the medication group separately (P<0.05). In the auricular point group, 16 h after operation the mean of VAS score was less than 3 points, but in the sham-auricular point group and the medication group, 48 h after operation, such a mean score of VAS was obtained. In 8, 72 h after operation, HAD score in the auricular point group was lower than that in the sham-auricular point group and the medication group respectively. In 24, 48 h after operation, the concentration of plasmaβ-endorphin was all higher than that in the sham-auricular point group and the medication group respectively (P<0.05). In 24 h after operation, the plasma concentration ofβ-endorphin in the sham-auricular point group was higher than the medication group (P<0.05). The incidence of adverse reaction in the auricular point group was lower than that in the sham-auricular point group and the medication group respectively (P<0.05). Auricular point sticking therapy relieves perioperative pain, shortens analgesic time, releases anxious and depressive emotions and reduces postoperative adverse reaction in the patients with partial lung resection. The analgesic mechanism is probably related to the increase of plasma concentration of β-endorphin.

Effect of total intravenous anesthesia or inhalation anesthesia on postoperative quality of recovery in patients undergoing total laparoscopic hysterectomy: A randomized controlled trial

Study objectiveTo investigate the effect of propofol-based total intravenous anesthesia (TIVA) or sevoflurane-based inhalation anesthesia on postoperative quality of recovery in patients undergoing total laparoscopic hysterectomy. DesignA prospective randomized controlled trial. SettingAn operating room, a postoperative recovery area, and a hospital ward. PatientsA total of 102 female patients scheduled for elective total laparoscopic hysterectomy were randomly divided into two groups: the propofol group (group P) or sevoflurane group (group S). InterventionsAnesthesia in group P was induced by propofol, fentanyl and rocuronium, and maintained by intravenous infusion of propofol and remifentanil. Anesthesia in group S was induced by a tidal volume inhalation technique with sevoflurane and rocuronium and maintained with sevoflurane and remifentanil. Patients in group P did not receive any volatile drugs. MeasurementsQuality of Recovery-40 (QoR-40), Pittsburgh Sleep Quality Index (PSQI) and Numerical Rating Scale (NRS) scores were assessed at 8, 24, 48, 72 h, 7 days and 30 days after surgery. Intraoperative hemodynamics, postoperative inflammatory indicators and adverse reactions were also recorded. Main resultsThe QoR-40 score and its 5 dimensions were similar in the two groups at each point in time (P > 0.05). Group S had less consumption of remifentanil (P < 0.001) but increased use of phenylephrine (P = 0.001) intraoperatively. PSQI scores were also comparable between groups at each point in time (P > 0.05). NRS scores at 72 h (P = 0.023) and 7 days (P = 0.017) after surgery, postoperative NLR (P = 0.024) and hs-CRP (P = 0.042), and the incidence of abdominal distension (P = 0.017) were significantly lower in group P than in group S. Multiple linear regression analyses demonstrated that duration of pneumoperitoneum and sleep quality were associated with postoperative recovery. ConclusionsThe choice of intravenous or inhalation maintenance anesthesia did not affect overall postoperative recovery as measured by the QoR-40 in patients undergoing total laparoscopic hysterectomy. Reducing the duration of pneumoperitoneum and improving sleep quality were conducive to postoperative recovery.

Clinical efficacy and safety between high-intensity focused ultrasound and uterine artery embolization for cesarean scar pregnancy: a systematic review and a meta-analysis.

It was reported that high-intensity focused ultrasound (HIFU) of cesarean scar pregnancy (CSP) can locally inactivate pregnancy tissue. Uterine artery embolization (UAE) can achieve good results for CSP too. To investigate the clinical efficacy and safety of HIFU and UAE in the treatment of cesarean scar pregnancy (CSP), we conducted this research. Multiple databases were used to search for relevant studies and articles related to HIFU, UAE, and CSP. The selected literature were retrospectively evaluated using Review Manager 5.2. In addition, forest plots, sensitivity analysis, and bias analysis were conducted for the included literature. Finally, 8 related studies met the inclusion criteria. There were no significant differences in postoperative adverse reactions and hospitalization time between the HIFU group and the UAE group. However, the normalization time of serum beta human chorionic gonadotropin (B-HCG) in the HIFU group was higher than that in the UAE group [MD =1.16, 95% confidence interval (CI), 0.09, 2.22, P=0.03, I2=93%], and the hospitalization cost in the HIFU group was significantly lower than that in the UAE group (MD =-8.81, 95% CI, -12.64, -4.97, P<0.00001, I2=99%). Our results show that HIFU and UAE have the same curative effect in the treatment of CSP, but HIFU has lower cost and fewer complications. These results supported that compared with UAE, HIFU is a better choice for CSP patients with long gestational age, large gestational sac diameter and high HCG level.

2021 Chitranjan S. Ranawat Award: Intraosseous vancomycin reduces periprosthetic joint infection in primary total knee arthroplasty at 90-day follow-up.

Infection complicating primary total knee arthroplasty (TKA) is a common reason for revision surgery, hospital readmission, patient morbidity, and mortality. Increasing incidence of methicillin-resistant Staphylococcus aureus (MRSA) is a particular concern. The use of vancomycin as prophylactic agent alone or in combination with cephalosporin has not demonstrated lower periprosthetic joint infection (PJI) rates, partly due to timing and dosing of intravenous (IV) vancomycin administration, which have proven important factors in effectiveness. This is a retrospective review of a consecutive series of primary TKAs examining incidence of PJI, adverse reactions, and complications using IV versus intraosseous (IO) vancomycin at 30-day, 90-day, and one-year follow-up. A retrospective review of 1,060 patients who underwent TKA between May 2016 to July 2020 was performed. There were 572 patients in the IV group and 488 in the IO group, with minimal 30 days of follow-up. Patients were followed up at regularly scheduled intervals (two, six, and 12 weeks). No differences between groups for age, sex, BMI, or baseline comorbidities existed. The IV group received an IV dose of 15 mg/kg vancomycin given over an hour preceding skin incision. The IO group received a 500 mg dose of vancomycin mixed in 150 ml of normal saline, injected into proximal tibia after tourniquet inflation, before skin incision. All patients received an additional dose of first generation cephalosporin. Evaluation included preoperative and postoperative serum creatinine values, tourniquet time, and adverse reactions attributable to vancomycin. Incidence of PJI with minimum 90-day follow-up was 1.4% (eight knees) in the IV group and 0.22% (one knee) in IO group (p = 0.047). This preliminary report demonstrated an reduction in the incidence of infection in TKA using IO vancomycin combined with a first-generation cephalosporin. While the study suffers from limitations of a retrospective, multi-surgeon investigation, early findings are encouraging. IO delivery of vancomycin after tourniquet inflation is a safe and effective alternative to IV administration, eliminating the logistical challenges of timely dosing. Cite this article: Bone Joint J2021;103-B(6 Supple A):13-17.