ObjectiveTo explore the effect of different ventilation modes on pulmonary complications (PCs) after laparoscopic weight loss surgery in obese patients. MethodsThe obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected, then were assigned into pressure-controlled ventilation-volume guaranteed (PCV-VG) group and volume controlled ventilation (VCV) group according to the different ventilation modes during anesthesia. The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared. The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis. ResultsA total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled, with 138 males and 156 females; Body mass index (BMI) was 30–55 kg/m2, (42.40±4.87) kg/m2. The postoperative PCs occurred in 63 cases (21.4%). There were 160 cases in the PCV-VG group and 134 cases in the VCV group. The anesthesia time, tidal volume at 5 min after tracheal intubation, peak inspiratory pressure and driving pressure at 5 min after tracheal intubation, 60 min after establishing pneumoperitoneum, and the end of surgery, as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group (P<0.05). The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model, such as the smoking history, American Society of Anesthesiologists classification, hypertension, BMI, operation time, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and intraoperative ventilation mode. It was found that the factors had no collinearity (tolerance>0.1, and variance inflation factor<10). The results of the multivariate logistic regression analysis showed that the patients with higher BMI and intraoperative VCV mode increased the probability of postoperative PCs (P<0.05). ConclusionsFrom the preliminary results of this study, for the obese patients underwent laparoscopic weight loss surgery, the choice of ventilation mode is closely related to the risk of developing postoperative PCs. In clinical practice, it is particularly important to pay attention to the risk of postoperative PCs for the patients with higher degree obesity.
ObjectiveTo observe the short-term intraocular pressure changes of the affected eye after the implantation of dexamethasone vitreous implant (Ozurdex), and indirectly understand the tightness of the scleral perforation of the 22G implant device.MethodsThis is a prospective cohort design clinical observational study. From January 2018 to January 2020, 90 eyes (90 patients) who underwent vitreous Ozurdex implantation in the Department of Ophthalmology of Beijing Hospital were included in the study. There were 52 males (52 eyes), and 38 females (38 eyes); they were 14-79 years old. Forty-three eyes (43 patients) had retinal vein occlusion with macular edema, 29 eyes (29 patients) had uveitis with or without macular edema, 18 eyes (18 patients) had diabetic macular edema. All eyes underwent standard scleral tunnel vitreous cavity implantation Ozurdex treatment. The intraocular pressure was measured with a non-contact pneumatic tonometer 10 min before implantation (baseline) and 10, 30 min and 2, 24 h after implantation. The difference were compared between the intraocular pressure at different time points after implantation and the baseline. Wilcoxon signed rank test was used to compare intraocular pressure between baseline and different time points after implantation.ResultsThe average baseline intraocular pressure of the affected eye was 14.85 [interquartile range (IQR): 11.60, 17.63] mmHg (1 mmHg=0.133 kPa). The average intraocular pressure at 10, 30 and 2, 24 hours after implantation were 11.90 (IQR: 8.95, 16.30), 13.75 (IQR: 9.95, 16.80), 13.60 (IQR: 10.95, 17.20), and 14.65 (IQR: 12.20, 17.50) mmHg. Compared with the baseline intraocular pressure, the intraocular pressure decreased at 10 and 30 minutes after implantation, the difference was statistically significant (P＜0.001, P=0.002); the intraocular pressure difference was not statistically significant at 2, 24 h after implantation (P=0.140, 0.280).ConclusionsThere is a statistically significant difference in intraocular pressure reduction compared with the baseline in 10 and 30 minutes after vitreous implantation of Ozurdex, and there is no statistically significant difference between 2, 24 hours. This suggests that the 22G scleral puncture port of the preinstalled implant device cannot be completely closed immediately, and short-term intraocular pressure monitoring after implantation should be appropriately strengthened.
ObjectiveTo investigate the clinical effect of combined air pressure wave and oral glucosamine in the treatment of knee osteoarthritis. MethodsWe chose 200 patients with knee osteoarthritis treated in the Department of Rehabilitation between April 2013 and March 2015 as our research subjects. The patients were randomly divided into observation group and control group with 100 in each. The control group accepted conventional physical therapy, while the observation group underwent normal physical therapy in combination with air pressure wave and oral glucosamine treatment. We compared the two groups in terms of curative effects. ResultsThe total effective rate was not significantly different between the two groups (P＞0.05) , but in terms of efficiency rate, the observation group (85.0%) was significantly superior to the control group (73.0%) (P ＜ 0.05) . ConclusionCombined air pressure wave and oral glucosamine treatment for knee osteoarthritis is high efficient, which is worthy of being popularized.
Venous pressure monitoring is an important indicator for the arteriovenous fistula evaluation. Direct static venous pressure monitoring is recognized as the most accurate way of venous pressure monitoring, which is widely used in the functional monitoring, functional evaluation of arteriovenous fistula, the diagnosis of complications and the evaluation of surgical efficacy. Venous pressure monitoring has obvious advantages and disadvantages, so it is necessary to improve relevant knowledge to correctly guide clinical diagnosis and treatment. In this paper, the study of static venous pressure monitoring of arteriovenous fistula was summarized, in order to improve the understanding of the significance and clinical application of static venous pressure monitoring of arteriovenous fistula.
Objective To explore the clinical application value of electrical impedance tomography (EIT) individualized adjustment of positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS). Methods The ARDS patients requiring mechanical ventilation who admitted between April 2019 and March 2022 were recruited in the study. They were randomly divided into 3 groups with 12 cases in each group. Optimal PEEP was set using ARDSnet method (a control group), lung ultrasound scoring method (LUS group) and EIT adjustment method (EIT group). The changes of hemodynamics, blood gas analysis, respiratory mechanics, extravascular lung water index and other indicators of the patients were recorded at each time point. Results There was no significant difference in PEEP between the EIT group and the LUS group, but PEEP in both the EIT group and the LUS group was significantly higher than the control group (P<0.05). After 12 hours of treatment, the dynamic lung compliance of the control group did not change significantly, while the dynamic lung compliance ventilation of the LUS group and the EIT group was significantly improved for 12 hours, and the improvement in the EIT group was significantly better than that in the control group (P<0.05). After treatment, the oxygenation index in the three groups was significantly increased, and the oxygenation index in the EIT group was significantly higher than that in the control group (P<0.05). There was no significant difference in hemodynamics between the three groups before and after treatment (P>0.05). The extravascular lung water index of the three groups after treatment was significantly decreased, and the LUS group and the EIT group decreased more significantly than the control group (P<0.05). Conclusion In the PEEP setting of ARDS patients, the use of EIT personalized adjustment method can effectively improve the patient’s lung compliance and oxygenation index, and reduce extravascular lung water, without affecting hemodynamics.
ObjectiveTo systematically review the effectiveness and safety of intensive blood pressure lowering in intracerebral hemorrhage (ICH). MethodsRandomised controlled trials (RCTs) and quasi-RCTs about ICH patients receiving intensive blood pressure lowering were searched from PubMed, EMbase, SCIE, The Cochrane Library (Issue 2, 2013), CBM, CNKI, VIP and WanFang Data until March, 2014. Literature was screened according to the exclusion and inclusion criteria by two reviewers independently and meta-analysis was conducted using RevMan 5.2 software after data extraction and quality assessment. ResultsA total of 24 studies were included involving 6 299 patients, of which 10 were RCTs and 14 were quasi-RCTs. The results of meta-analysis showed that intensive blood pressure lowering was superior to guideline-recommended intervention in reducing 24-h hematoma expansion rates (OR=0.36, 95%CI 0.28 to 0.46, P < 0.05), 24-h hematoma expansion volume (MD=-3.71, 95%CI-4.15 to-3.28, P < 0.05) and perihematomal edema volume (MD=-1.09, 95%CI-1.92 to-0.22, P < 0.05). Meanwhile, intensive blood pressure lowering improved 21-d NIHSS score (MD=-3.44, 95%CI-5.02 to-1.87, P < 0.05). But there was no significant difference in mortality and adverse reaction between the two groups. ConclusionCurrent evidence shows that intensive blood pressure lowering could reduce hematoma expansion volume and perihematomal edema volume, which is beneficial to recovery of neurological function, but ICH patients' long-term prognosis needs to be further studied. Due to the limited quantity and quality of the included studies, high quality studies are needed to verify the above conclusion.
Hypertension is the primary disease that endangers human health. A convenient and accurate blood pressure measurement method can help to prevent the hypertension. This paper proposed a continuous blood pressure measurement method based on facial video signal. Firstly, color distortion filtering and independent component analysis were used to extract the video pulse wave of the region of interest in the facial video signal, and the multi-dimensional feature extraction of the pulse wave was preformed based on the time-frequency domain and physiological principles; Secondly, an integrated feature selection method was designed to extract the universal optimal feature subset; After that, we compared the single person blood pressure measurement models established by Elman neural network based on particle swarm optimization, support vector machine (SVM) and deep belief network; Finally, we used SVM algorithm to build a general blood pressure prediction model, which was compared and evaluated with the real blood pressure value. The experimental results showed that the blood pressure measurement results based on facial video were in good agreement with the standard blood pressure values. Comparing the estimated blood pressure from the video with standard blood pressure value, the mean absolute error (MAE) of systolic blood pressure was 4.9 mm Hg with a standard deviation (STD) of 5.9 mm Hg, and the MAE of diastolic blood pressure was 4.6 mm Hg with a STD of 5.0 mm Hg, which met the AAMI standards. The non-contact blood pressure measurement method based on video stream proposed in this paper can be used for blood pressure measurement.
ObjectiveTo investigate the safety and efficacy of intermittent pneumatic compression (IPC) in the treatment of deep venous thrombosis (DVT). MethodsThe clinical data of 496 patients with DVT who were treated in our hospital from January 2010 to October 2014 were analyzed retrospectively, to compare the time of venous pressure decreased to normal (T1) and time of circumference difference decreased to normal (T2) in patients received pure therapy (control group) and pure therapy combined with IPC (combination group), according to different types of patients in acute, sub-acute, and chronic phase. In addition, comparison of the remission rate of pulmonary embolism (PE), incidence of PE, and recurrence of DVT was performed between the control group and combination group too. Results① For DVT patients in acute stage, the time of T1 and T2 of patients in central type, peripheral type, and mixed type who received anticoagulant therapy/systemic thrombolysis/catheter thrombolysis+IPC, were significantly shorter than those patients who received only anticoagulant therapy/systemic thrombolysis/catheter thrombolysis (P<0.05). For DVT patients in sub-acute stage, the time of T1 and T2 of patients in central type and mixed type who received anticoagulant therapy/systemic thrombolysis+IPC, were significantly shorter than those of patients who received only anticoagulant therapy/systemic thrombolysis (P<0.05), the time of T1 of patients in peripheral type who received anticoagulant therapy/systemic thrombolysis+IPC, were significantly shorter than those of patients who received only anticoagulant therapy/systemic thrombolysis (P<0.01), but the time of T2 of patients in peripheral type didn't differed between patients who received only anticoagulant therapy/systemic thrombolysis and anticoagulant therapy/systemic thrombolysis +IPC (P>0.05). For DVT patients in chronic stage, the time of T1 and T2 of patients in central type and mixed type didn't differed between patients who received only anticoagulant therapy and anticoagulant therapy +IPC (P>0.05); the time of T1 of patients in peripheral type who received anticoagulant therapy+IPC, were significantly shorter than those of patients who received only anticoagulant therapy (P<0.05), but the time of T2 didn't differed with each other (P>0.05). ② There were 63 patients in control group and 47 patients in combination group had PE before treatment. After the treatment, the PE symptom of control group relieved in 56 patients (88.89%, 56/63) and maintained in 7 patients (11.11%, 7/63), the symptom of combination group relieved in 44 patients (93.62%, 44/47) and maintained in 3 patients (6.38%, 3/47), so the remission rate of PE symptom in combination group was higher (P<0.05). There were 6 patients suffered from new PE in control group[4.26% (6/141)] and 0 in combination group[0 (0/245)] after treatment in patients who hadn't PE before treatment, and the incidence of PE was lower in combination group (P<0.05). ③ There were 325 patients were followed up for 3-36 months with the median time of 27 months, including 157 patents in control group and 168 patients in combination group. During the follow-up period, 74 patients recurred[47.13% (74/157)] in control group and 46 patients recurred[27.38% (46/168)] in combination group, and the recurrence rate was lower in combination group (P<0.05). In addition, 41 patients suffered from post-thrombotic syndrome[26.11% (41/157)] in control group and 27 patients[16.07% (27/168)] in combination group, and the incidence of post-thrombotic syndrome was lower in combination group (P<0.05). ConclusionsIPC can significantly shorten the time of venous pressure and the circumference difference decreased to normal for DVT patients in acute stage and majority DVT patients in sub-acute stage, and it can relieve the clinical symptoms of PE, reduce the incidence rate of PE and recurrence rate of DVT. Therefore, IPC is a safe, reliable, and effective treatment for DVT patients in acute stage and majority DVT patients in sub-acute stage.
Objective\ To investigate the clinical significance of measuring central venous pressure in patients after cardiac surgery.\ Methods\ Twenty four patients in postoperative cardiac surgery were randomly chosen, and investigated under three fettles:(1) The patients were sent into intensive care unit on mechanical ventilation; (2) They were all conscious and on mechanical ventilation 8 hours after operation; (3) 24 hours after operation, the patients were conscious with normal breathing.
Objective Mendelian randomization (MR) was used to analyze the potential relationship between blood pressure and proliferative diabetic retinopathy (PDR). MethodsTwo-sample MR analysis was performed using summary statistics from genome-wide association studies. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were selected as the exposure, PDR as the outcome. The instrumental variable of SBP and DBP came from the publicly available data of the the UK Medical Research Council Comprehensive Epidemiology Unit and Neale Laboratory; the outcome data (8 681 cases in the case group, 204 208 cases in the control group, European population) are from the FinnGen database. Inverse variance weighting (IVW) and weighted median (WM) were used to analyze the potential relationships between SBP, DBP and PDR. ResultsMR analysis showed that IVW [SBP: odds ratio (OR)=1.36, 95% confidence interval (CI) 1.17-1.57, P=4.22E-05; DBP: OR=1.29, 95%CI 1.11-1.51, P=8.6E-04], WM (SBP: OR=1.33, 95%CI 1.07-1.66, P=0.009; DBP: OR=1.28, 95%CI=1.03-1.59, P=0.002). The results showed that elevated SBP and DBP increased the risk of PDR. ConclusionBlood pressure (SBP, DBP) change is positively correlated with the risk of PDR.