Objectives To analyze risk factors associated with conversion to open surgery of laparoscopic repair for perforated peptic ulcer. Methods From January 2009 to December 2014, 235 patients underwent laparoscopic repair for perforated peptic ulcer in the Chengdu 5th Hospital, were enrolled in this study. These patients were divided into laparoscopic repair group (n=207) and conversion to open surgery group (n=28). The characteristics, clinical outcomes, and prognosis factors were compared between these two groups. The receiver operating characteristic (ROC) curve was used to determine the critical cutoff value for diameter and duration of perforation for predicting conversion to open surgery. Results There were no significant differences of the age, gender, body mass index, comorbidity, history of ulcer, smoking history, history of nonsteroidal antiinflammatory drugs or steroids use, history of alcohol use, American Society of Anesthesiologists classification on admission, white blood cell count on admission, C reaction protein on admission, surgeons, suture method, and location of perforation between these two groups (P>0.05). The patients in the conversion to open surgery group had a higher procalcitonin (PCT) level on admission (P=0.040), longer duration of peroration (P<0.001), larger diameter of peroration (P<0.001), longer hospital stay (P=0.002), higher proportion of patients with Clavien-Dindo classification Ⅰ and Ⅱ (P<0.001), longer gastrointestinal function recovery time (P=0.003), longer analgesics use time (P<0.001), and longer off-bed time (P=0.001) as compared with the laparoscopic repair group. The results of logistic regression analysis showed that the peroration duration on admission〔OR: 2.104, 95%CI (1.124, 3.012),P=0.020〕and peroration diameter on admission〔OR: 2.475, 95%CI (1.341, 6.396),P=0.013〕were two predictors of conversion to open surgery. For the diameter of perforation, 8.0 mm was the critical cutoff value for predicting conversion to open surgery by ROC curve analysis, the sensitivity was 76%, the specificity was 93%, and the area under the curve (AUC) was 0.912. For the duration of perforation, 14 h was the critical cutoff value to predict conversion to open surgery, the sensitivity was 86%, the specificity was 71%, and theAUC was 0.909. Conclusions The preliminary results in this study show that diameter of perforation of 8 mm and duration of perforation of 14 h are two reliable risk factors associated with conversion to open surgery for perforated peptic ulcer. Also, PCT level would mightbe considered as a helpful risk factor for it.
目的：探討單純腦白質疏松癥(LA)以及LA合并腦梗死及其MRI影像學嚴重程度與年齡、性別、高血壓、糖尿病相關性初步分析。方法：根據郭氏等2003年制定的LA診斷標準納入168例腦白質疏松癥患者，分為A、B兩組：A組95例為單純腦白質疏松(LA)，B組73例為LA合并腦梗死(LA+CI)。兩組患者均行頭MRI檢查。根據Kinkel等的方法將T2WI顯示腦室周圍高信號范圍及程度分為5型.結果：年齡與腦白質疏松的嚴重程度呈線性相關性(Plt;0.05)，男性與女性間比較腦白質疏松的發生率無顯著差異(Pgt;0.05)，LA以及LA+CI患者，其高血壓及糖尿病伴發率較高，而且LA+CI組高于LA組(高血壓Plt;0.01，糖尿病Plt;0.01)，LA患者MRI表現以1型為主，LA+CI患者表現以2型為主，Plt;0.01)。結論：腦白質疏松癥的嚴重程度與年齡密切相關，LA的發生率在男女性別間無明顯差異。高血壓、糖尿病可能是LA的危險因素。LA+CI組與單純LA組相比，其高血壓、糖尿病伴發率更高且MRI表現程度更重。
Objective To explore the safety and efficiency of cervical expansion balloon in promoting cervical ripening of cicatrical uter women with full-term pregnancy attempting vaginal delivery. Methods Fifty cases of pregnant women at the third trimester with cicatrical uter admitted to Nanshan District Maternal and Child Health Care Hospital of Shenzhen from July 2015 to March 2016 were retrospectively and randomly collected as the observation group. Another 50 pregnant women at the third trimester with normal uter admitted to the same hospital in the same period were retrospectively and randomly collected as the control group. All the cases had indications for labor induction, and had intention and conditions of vaginal delivery. Cervical expansion balloons were used in the two groups to promote cervical ripening. The effective rate of promoting cervical ripening, the outcomes of delivery and the incidences of adverse outcomes were compared between the two groups. Results The differences in effective rate of promoting cervical ripening and success rate of induced labor of cervical ripening of pregnant women between the observation group (66%, 76%) and the control group (76%, 84%) were not statistically significant (P>0.05). There were no significant differences in the time of birth process, amout of postpartum bleeding, birth immediate Apgar score, neonatal birth weight, and vaginal delivery rate, and the incidences of acute chorioamnionitis and cervical laceration of pregnant women between the two groups (P>0.05). Incomplete uterine rupture occurred in one case in the observation group, while none in the control group; neonatal mild asphyxia occurred in one case in the control group, while none in the observation group; the differences were not statistically significant (P>0.05). No postpartum hemorrhage occurred in the two groups. Conclusions Under the premise of strictly following the indications, cervical expansion balloon can be used in promoting cervical ripening at the third trimester of pregnant women with cicatrical uter attempting vaginal delivery, improve the success of attempting vaginal delivery, reduce the occurrence of reduplicated cesarean section, and not increase the incidence of maternal and fetal adverse outcomes.
Secondary and tertiary hyperparathyroidism are common complications in patients with chronic kidney disease, especially in end stage renal disease. Surgery is an important method for the treatment of secondary and tertiary hyperparathyroidism. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism is the first evidence based guideline focus on renal hyperparathyroidism surgical management. Recommendations using the best available evidence by a panel of 10 experts in secondary and tertiary renal hyperparathyroidism constructed this guideline, which provides evidence-based, individual and optimal surgical management of secondary and tertiary renal hyperparathyroidism. This paper made a guideline interpretation on the indications of surgery, imaging examination, preoperative and perioperative management, relevant evaluation and treatment during perioperative period, and intraoperative parathyroid hormone monitoring during operation, and so on.
The patency of vascular access is of great significance to hemodialysis patients. Combining with guidelines and literature associated with vascular access for dialysis in recent years, the authors interpret the effectiveness and limitations of prophylactic drug strategies, including using fish oil, anticoagulation, anti-platelet, lipid-lowering agents, etc., in order to promote the proper use of these agents in clinical practice, and improve the effect of prophylaxis and treatment of vascular access dysfunction.
ObjectiveTo investigate the role of multiple disciplinary team (MDT) during surgical treatment of renal secondary hyperparathyroidism (SHPT), and identify management points of Departments of Nephrology and Endocrinology.MethodsThe data of patients with chronic kidney disease undergoing surgical treatment for SHPT in West China Hospital of Sichuan University between January 2009 and December 2018 were retrospectively collected. We explained the surgical treatment of MDT in the management of renal SHPT, and compared the changes before and after the establishment of MDT.ResultsA total of 187 patients including 101 males and 86 females were enrolled, with an average age of (47.60±11.28) years old and median dialysis vintage of 7 years. Under MDT, the number of patients with parathyroidectomy increased [(8.50±5.10) vs. (59.50±2.12) patients/year, P<0.001] and the completion rate of preoperative examinations were greatly improved (P<0.001). The success rate of surgery was also increased (86.8% vs. 97.5%, P=0.010). Proportion of patients who were admitted to the Department of Nephrology was significantly increased (39.7% vs. 84.9%, P<0.001). Most patients after surgery were transferred to the Department of Endocrinology (5.9% vs. 77.3%, P<0.001) to manage postoperative complications and metabolic bone disease, and thus normalized the management of SHPT.ConclusionsThe MDT contributes to management of renal SHPT, which is worthy of popularization and spreading. The management of internal medicine departments during surgical treatment of SHPT based on MDT is important, because they can be helpful to complete preoperative examinations and preoperative preparation as well as to alleviate postoperative complications.
ObjectiveThis study aimed to revise the perioperative recovery scale for integrative medicine (PRSIM) based on item response theory (IRT). MethodsUnder the guidance of IRT, a total of 349 patient data collected during the development of the original version of PRSIM at Guangdong Provincial Hospital of Chinese Medicine were used. Principal component analysis was performed using SPSS 18.0 software to test the unidimensionality. The R language was utilized for parameter estimation, including discrimination coefficient, difficulty parameters and information content, as well as drawing item characteristic curves to assess item quality and estimate item functioning differences. A comprehensive screening process was carried out by combining expert consultations, patient evaluations, and discussions within a core group. ResultsThe degree of discrimination of all items ranged from ?0.535 to 2.195. The difficulty coefficient ranged from ?10.343 to 5.461, and the average information content of all items ranged from 0.043 to 1.075. Based on the criteria for parameter selection, nine items were retained. The results of expert consultations indicated the removal of 5 items and the modification of 7 items. After discussion within the core group, a final decision was made to remove 5 items. ConclusionBased on a synthesis of IRT and expert consultation feedback, and following discussions within the core group, a revised version comprising 15 items is retained and modified from the original 20 items.
目的 探討上皮細胞鈣黏蛋白（E-Cadherin）、尿激酶型纖溶酶原激活劑（uPA）表達與乳腺癌的浸潤、淋巴結轉移的關系。 方法 采用免疫組織化學鏈霉菌抗生物素蛋白-過氧化物酶連接法對乳腺纖維腺瘤、乳腺腺病和乳腺癌各40例蠟塊中E-Cadherin、uPA表達進行研究。 結果 乳腺纖維腺瘤、腺病和乳腺癌中E-Cadherin陽性率分別為85.0%、82.5%和20.0%，三者差異有統計學意義（P＜0.05）；E-Cadherin表達陰性患者淋巴結轉移率（90.6%）高于E-Cadherin表達陽性者（25.0%），差異有統計學意義（P＜0.01）。uPA在乳腺纖維腺瘤、腺病均呈陰性表達，在乳腺癌中的陽性率為60.0%，三者差異有統計學意義（P＜0.05）；uPA表達陽性患者淋巴結轉移率（88.5%）顯著高于陰性者（50.0%），兩者的表達差異有統計學意義（P＜0.05）。 結論 E-Cadherin和uPA的表達與乳腺癌的浸潤轉移密切相關，同步檢測其在乳腺癌組織中的表達并綜合分析二者之間的關系，對評價乳腺癌細胞的侵襲轉移能力及預后判斷具有一定價值。uPA在乳腺癌中表達率較高，而且和乳腺癌的生物學特性有關，它對提示預后和開展靶向治療有指導意義。
The estimation of the minimal important difference (MID) in patient-reported outcomes (PRO) relies on various selection principles and statistical methods, resulting in varying degrees of credibility among studies. When applying these findings, it is crucial to consider their evaluation outcomes. In the context of widely accepted MID studies based on the anchoring method, the credibility of the MID of PRO is influenced by the selection of anchors and the statistical methods employed for estimation. Variations in the anchors utilized, differences in clinical trial designs, disparities in the characteristics of measurement subjects and environment, as well as the control of biases in studies, can all contribute to inconsistencies in the MID of PRO. In response to this, McMaster University in Canada has developed a credibility evaluation tool specifically for MID studies in PRO. The tool comprises five core items and four additional items. The five core items encompass an evaluation framework that assesses: (1) Is the patient or necessary proxy responding directly to both the PRO and the anchor? (2) Is the anchor easily understandable and relevant for patients or necessary proxy? (3)Has the anchor shown good correlation with the PRO? (4) Is the MID precise? (5) Does the threshold or difference between groups on the anchor used to estimate the MID reflect a small but important difference? The four additional items concerning transition-rated anchors assess: (1) Is the amount of elapsed time between baseline and follow-up measurement for MID estimation optimal? (2) Does the transition item have a satisfactory correlation with the PRO score at follow-up? (3) Does the transition item correlate with the PRO score at baseline? (4) Is the correlation of the transition item with the PRO change score appreciably greater than the correlation of the transition item with the PRO score at follow-up? Given the relative weights of each item in the tool are uncertain and environment-dependent, items are not scored; instead, an overall judgment is made using a qualitative rating approach. This article introduces the specific items of this tool and illustrates the evaluation process through a case study to improve its use in optimizing PRO results presentation and interpretation in clinical trials, reviews, assessments, and guidelines.