Objective:To investigate the effect of TSH inhibition therapy in the postoperative management of patients with differentiated thyroid cancer.Methods:Seventy patients diagnosed with differentiated thyroid cancer were s...Objective:To investigate the effect of TSH inhibition therapy in the postoperative management of patients with differentiated thyroid cancer.Methods:Seventy patients diagnosed with differentiated thyroid cancer were selected for the study.TSH inhibition therapy was administered to the research group,while thyroxine replacement therapy was provided to the control group during the postoperative management phase.This allowed for a comparative analysis between the two groups.Results:In comparison with the control group,the research group exhibited significant decreases in serum TSH,T3,and T4 levels after treatment,while FT4 and FT3 levels significantly increased(P<0.05).Additionally,significant decreases in Tg,VEGF,TSGF,CD44V6,and sIL-2R levels were observed in the research group after treatment(P<0.05).No significant differences were found in pre-treatment thyroid function between the two groups(P>0.05).Conclusion:The application of TSH inhibition therapy in the postoperative management of patients with differentiated thyroid cancer demonstrates promising outcomes.展开更多
Endoscopic submucosal dissection(ESD)has been clinically proved to have prominent advantages in the treatment of early gastrointestinal cancers over traditional surgery,including less trauma,fewer complications,a quic...Endoscopic submucosal dissection(ESD)has been clinically proved to have prominent advantages in the treatment of early gastrointestinal cancers over traditional surgery,including less trauma,fewer complications,a quicker recovery and lower costs.During the procedure of ESD,appropriate and multifunctional submucosal injected materials(SIMs)as submucosal cushions play an important role,however,even with many advances in design strategies of SIMs over the past decades,the performance of the submucosal cushions with postoperative management function seems to be still unsatisfactory.In this review,we gave a brief historical recount about the clinical development of SIMs,then some common applications of hydrogels used as SIMs in ESD were summarized,while an account of the universal challenges during ESD procedure was also outlined.Going one step further,some cutting-edge functional strategies of hydrogels for novel applications in ESD were exhibited.Finally,we concluded the advantages of hydrogels as SIMs for ESD as well as the treatment dilemma clinicians faced when it comes to deeply infiltrated lesions,some technical perspectives about linking the clinical demand with commercial supply were also proposed.Encompassing the basic elements of SIMs used in ESD surgery and the corresponding postoperative management requirements,this review could be a good reference for relevant practitioners in expanding the research horizon and improving the well-being index of patients.展开更多
Objective:This study was designed to determine the nurse assessment of postoperative pain and its management in selected hospitals,Benin City,Edo State,Nigeria.Materials and Methods:A descriptive cross-sectional surve...Objective:This study was designed to determine the nurse assessment of postoperative pain and its management in selected hospitals,Benin City,Edo State,Nigeria.Materials and Methods:A descriptive cross-sectional survey was adopted.The target population consist of 222 purposely nurses who are in the cadre of nursing officer II to chief nursing officer who works in the various surgical wards/units of the selected health facilities.The data were collected from the participants using the pretested structured questionnaire developed by the researcher.Results:Results showed that 66.2%of nurses had a poor level of knowledge on postoperative pain assessment.The McGill Pain Questionnaire was the most used pain assessment tool with a mean score of 2.84 whereas the Dallas Pain Questionnaire was the least used with a mean score of 1.90.“Providing clean,calm,and well-ventilated ward environment”(3.69±0.61)was the most used nonpharmacological method for postoperative pain management,followed by“distraction,relaxation,and guided imagery”(3.52±0.50),“dressing,bandage,splint,and reinforce wound sites postoperatively”(3.39±0.54),and“early ambulation/exercise”(3.20±0.62).The most used pharmacological interventions were“acetaminophen”(3.63±0.55),“topical anesthetic”(2.92±0.62),“nonselective nonsteroidal anti-inflammatory drugs”(2.87±0.43),and“mixed opioid agonist-antagonist”(2.56±0.56).Conclusion:There is a poor level of knowledge on postoperative pain assessment among nurses in this study setting.It is,therefore,pertinent for hospitals to organize continuous in-service training for postoperative pain assessment and management,especially on nonpharmacological approaches among nurses.展开更多
Total knee replacement,a common surgery among the elderly primarily necessitated by osteoarthritis,replaces the damaged knee joint with an artificial one.Given the aging population and the increasing prevalence of suc...Total knee replacement,a common surgery among the elderly primarily necessitated by osteoarthritis,replaces the damaged knee joint with an artificial one.Given the aging population and the increasing prevalence of such surgeries,the article highlights the critical need for effective postoperative care strategies.This editorial provides an overview of rehabilitation care for pain in elderly knee replacement patients,emphasizing the importance of a multimodal approach to postoperative recovery.Furthermore,the article advocates for a patient-centered,comprehensive rehabilitation regimen that enhances recovery and quality of life in elderly patients undergoing knee replacement surgery.展开更多
Anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA） is a rare congenital anomaly It demonstrated the combined effects of the absence of a normal coronary flow with a coronary steal and th...Anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA） is a rare congenital anomaly It demonstrated the combined effects of the absence of a normal coronary flow with a coronary steal and the profound ischemia that can produce left ventricular dysfunction and mitral regurgitation. We here introduce the postoperative management of patients with repair of anomalous ori artery from the pulmonary artery, with an emphasis on its outcome. Methods Reco gin rds of the left coronary of 31 patients with anomalous origin of the left coronary artery from the pulmonary artery receiving surgery from 1998 to 2010 were reviewed retrospectively, 10 of which were treated with the mitral valve surgically at the same time. The age of patients was 4 months to 16 years （m kilograms）, all of which were diagno edian, sed of anomalous origin of the left coronary artery from the pulmonary by echocardiography and cardiac catheterization. After surgery, electrocardiogram, echocardiography, arterial blood pressure, transcutaneous oxygen saturation and central venous pressure were monitored. Common postoperative complications in our group were analysed. And preoperative and postoperative data including area of mitral regurgitation, left ventricular systolic diameter and left ventricular distolic diameter were obtained. Cardiopulmonary bypass time and mechanical ventilation time of postoperative patients with no pneumonia were compared with those with pneumonia. Binary logistic regression was applied for the analysis of the risk factors of postoperative pneumonia. Results Of 31 patients, 30 survived after surgery with early mortality of 3.23%. One patient died of severe low cardiac output syndrome. Mechanical ventilation time was 4 hours to 168 hours hours （mean, 39.68 ± 50.52 hours; median, 18 hours）. ICU stay was 16 hours to 425 hours （mean, 111.65 ± 127.03 hours; median, 44 hours）. In our group, common postoperative complications were myocardial ischemia（n = 12, 36.4%）, infection（n = 11, 33.3%） including pneumonia （n = 10, 30.3%）, postoperative tachyarrhythmia（n = 5, 15.2%）, low postoperative cardiac output（n = 2, 6.1%）, endocarditis（n = 1, 3.0%）. Compared with preop-erative data, postoperative data including area of mitral regurgitation, left ventricular systolic diameter and left ventricular distolic diameter decreased remarkably（P 〈 0.01）, with left ventricular ejection fraction significantly improved （P 〈 0.05）. Compared with mechanical ventilation time of patients with no postoperative pneumonia, time of those with pneumonia apparently prolonged（P 〈 0.01 ） while cardiopulmonary bypass time extended （P 〈 0.05）. Mechanical ventilation time was a risk factor of postoperative pneumonia （OR = 1.041, OR 95%CI = （1.010, 1.073）. Conclusions Proper therapy strategies according to the knowledge of the ALCAPA disease and the change of postoperative pathology and physiology play an important role in avoiding the postoperative complications and improving postoperative outcomes.展开更多
BACKGROUND Currently,the use of dienogest in clinical practice has increased significantly,and many studies have focused on its effectiveness and safety in the treatment of endometriosis and adenomyosis;however,the ef...BACKGROUND Currently,the use of dienogest in clinical practice has increased significantly,and many studies have focused on its effectiveness and safety in the treatment of endometriosis and adenomyosis;however,the effects of treatment with dienogest on uterine fibroid size in patients with endometriosis or adenomyosis have not been investigated.AIM To explore changes in fibroid size in patients with concomitant uterine fibroids undergoing dienogest treatment for endometriosis or adenomyosis and to evaluate the effectiveness and safety of the drug.METHODS The clinical data of patients with uterine fibroids treated with dienogest for endometriosis or adenomyosis at Peking University First Hospital from January 2021 to January 2023 were retrospectively analyzed.RESULTS The maximum uterine fibroid diameter and volume increased after 3 months,6 months and 1 year of dienogest treatment compared with those before treatment(P<0.01).The maximum diameter and volume of the uterine adenomyoma increased after 3 months of dienogest treatment but decreased after 6 months and 1 year of treatment compared with those before treatment,but the difference was not significant(P>0.05).Endometrial thickness and antigen 125 levels were significantly thinner and decreased,respectively,after dienogest treatment(P<0.01).Pearson's correlation analysis revealed that the increase in uterine fibroid volume after 3 months of dienogest treatment was positively correlated with the basic uterine fibroid volume(r=0.792,P<0.01).Among 64 patients with dysmenorrhea,63 experienced significant relief of dysmenorrhea after 6 months of treatment with dienogest,and all patients experienced significant relief of dysmenorrhea after 12 months.Patients were able to tolerate the drugs,with an average drug tolerance score of 8.73.CONCLUSION The use of dienogest in patients with endometriosis or adenomyosis combined with uterine fibroids can effectively relieve the patient's pain symptoms and significantly reduce the sizes of ovarian endometriotic cysts,but it cannot inhibit uterine fibroid growth.展开更多
BACKGROUND Coronavirus disease 19(COVID-19)is a global pandemic and has had a profound impact on our routine surgical activities.Acute appendicitis is the most common abdominal emergency worldwide.Therefore,it is high...BACKGROUND Coronavirus disease 19(COVID-19)is a global pandemic and has had a profound impact on our routine surgical activities.Acute appendicitis is the most common abdominal emergency worldwide.Therefore,it is highly essential to assess the influence the pandemic has on acute appendicitis.AIM To assess the efficacy of the management of acute appendicitis during the COVID-19 pandemic.METHODS We retrospectively analyzed 90 patients who presented with acute appendicitis during the outbreak of COVID-19 in Jiaxing,China.Clinical data regarding appendectomies patients were also collected for the corresponding time frame from 2019.Preoperative management,intraoperative protective measures,and postoperative management were conducted.RESULTS After screening,six patients were identified as unqualified due to fever and were then referred to the COVID-19 expert group.The results of the nucleic acid test were negative.Of the 76 patients enrolled in the simple group,nine patients received medication therapy,and all others underwent surgery.From this same group,66 patients were diagnosed with suppurative appendicitis,and one patient was diagnosed with perforated appendicitis after surgery.There were 14 patients in the complex group,for which the postoperative diagnosis indicated perforated appendicitis.The proportion of men with perforated appendicitis was higher than that in 2019(P<0.05).The chief complaint duration for perforated appendicitis patients in 2020 was longer than that in 2019(P<0.05).The routine blood test showed that white blood cell counts and neutrophil ratios were higher in perforated appendicitis patients in 2020 than in 2019(P<0.05).The ratio of open appendectomies to the amount of mean blood loss during surgery was greater in 2020 than in 2019(P<0.05).Online consultation after discharge was selected in 59 cases(65.6%).No perioperative infection with COVID-19 or long-term postoperative complications were found.CONCLUSION The management of acute appendicitis from Jiaxing effectively reduced the influence of the pandemic and minimized the risk of nosocomial infection.展开更多
Besides peripheral nerve injury,the acute inflammation is one of the pathological features of tissues after surgery,which exacerbates the postoperative pain,especially in the first 48 h after the surgery.Multimodal an...Besides peripheral nerve injury,the acute inflammation is one of the pathological features of tissues after surgery,which exacerbates the postoperative pain,especially in the first 48 h after the surgery.Multimodal analgesia(MMA),such as the combination of non-steroidal anti-inflammatory drugs(NSAIDs)with local anesthetics,has shown enhanced potency compared with the usage of local anesthetics alone.However,rare formulations can provide long-term analgesia at a single dose.Herein,bupivacaine(BUP,a local anesthetic)loading poly(lactic-co-glycolic acid)(PLGA)nanoparticles(NPB)were coated with meloxicam(MLX,an NSAID)loading lipid bilayer(LPM),forming a core–shell nanosystem(NPB@LPM)to provide enhanced and long-term analgesia to treat postoperative pain.MLX was encapsulated in the lipid shell,which enabled high dose MLX to be released in the first 48 h after surgery to reduce the acute inflammation induced pain.BUP was encapsulated in the PLGA core to provide a long-term release for the nerve block.This nanosystem provided a 7-day(whole recovery cycle)effective analgesia in the Brennan’s plantar incision rat model.The tissue reactions of NPB@LPM are benign.This work will provide feasible strategies on designing drug delivery systems for postoperative pain management.展开更多
Rib cartilage is the most reliable material for structural support and dorsal augmentation in Asian rhinoplasty with its robust strength and bountiful amount. Its value is incomparable especially in complex, cartilage...Rib cartilage is the most reliable material for structural support and dorsal augmentation in Asian rhinoplasty with its robust strength and bountiful amount. Its value is incomparable especially in complex, cartilage-depleted revision surgery or major reconstruction. There are many articles regarding harvesting and carving of rib cartilage in rhinoplasty,however, only few has focused on preoperative and postoperative issues. Preoperatively, evaluating cartilage availability, assessing quality and quantity of cartilage, and choosing the cartilage to harvest are necessary. Although easily overlooked, proper postoperative management of rib cartilage rhinoplasty patients is key to prevent infection and heighten patient satisfaction. Here in, I would like to introduce how I evaluate rib cartilage rhinoplasty patients preoperatively and manage them postoperatively to maximize the surgical results.展开更多
To investigate best diagnosing methods and therapy for patients with biliary tract complications after liver transplantation and analyze related factors Methods A review was made of data collected from 96 patients, ...To investigate best diagnosing methods and therapy for patients with biliary tract complications after liver transplantation and analyze related factors Methods A review was made of data collected from 96 patients, and confirmed by retrospective case notes examination Results A total of 94 patients (97 grafts) survived more than 2 days after transplantation; of whom, 92 had an end to end biliary anastomosis with a T tube The average follow up was 5 8 months (range: 0 3-10 2 months) Among the 94 patients, eight (8 5%, 8/94) had complications: leakage during T tube removal (2 patients), leakage at an earlier stage (2), simultaneous stricture and leak (2) and just stricture (2) Six patients with biliary tract complications had predisposing factors including hepatic artery stenosis (2 patients, including one hepatic artery stenosis combined with severe rejection, hepatic artery thrombosis (3), and donor recipient bile duct mismatch (1) There was no difference in cold ischemic time With hepatic artery thrombosis and/or stenosis 】50%, five patients were re transplanted; without hepatic artery thrombosis and/or stenosis 【50%, three patients required endoscopic stenting and radiological percutaneous drainage of bile collection with or without balloon dilation All patients survived Conclusions Biliary strictures occur later than leaks after surgery Without hepatic artery thrombosis and/or stricture, there is no need for surgery; with hepatic artery thrombosis and/or stricture 】50%, re transplantation is needed as early as possible展开更多
Patients who undertake cardiac surgery usually manifest discomforts. Comfort care plays an im- portant role in the postoperative management of a cardiac surgery patient. Methods A self-made General Com- fort Scale was...Patients who undertake cardiac surgery usually manifest discomforts. Comfort care plays an im- portant role in the postoperative management of a cardiac surgery patient. Methods A self-made General Com- fort Scale was used to evaluate the discomfort factors of 156 adult patients who underwent cardiac surgery in our department of Guangdong General Hospital from January to April 2014. All patients had open chest cardiac sur- gery under general anesthesia and cardiopulmonary bypass. The reasons for the discomfort were collected and the appropriate comfort cares were implemented. Results Our data showed that the main factors influencing the comfort of surgical patients included pain, thirst, hunger, nausea, vomit, abdominal distension, sleeping disorder, postural discomfort, surrounding and psychological causes etc. Among the 156 adult patients, 153 patients com- plained of thirst, 141 patients felt painful, 96 patients felt hungry, and 67 patients had sleeping disorders. These discomfort factors affected the treatment and rehabilitation of patients. Conclusions Basic and specific comfort and appropriate nursing cares should be carried out to alleviate the discomfort factors such as sleep disorder, pain and endotracheal intubation, which could protect patients＇ benefit and promote their rehabilitation.展开更多
文摘Objective:To investigate the effect of TSH inhibition therapy in the postoperative management of patients with differentiated thyroid cancer.Methods:Seventy patients diagnosed with differentiated thyroid cancer were selected for the study.TSH inhibition therapy was administered to the research group,while thyroxine replacement therapy was provided to the control group during the postoperative management phase.This allowed for a comparative analysis between the two groups.Results:In comparison with the control group,the research group exhibited significant decreases in serum TSH,T3,and T4 levels after treatment,while FT4 and FT3 levels significantly increased(P<0.05).Additionally,significant decreases in Tg,VEGF,TSGF,CD44V6,and sIL-2R levels were observed in the research group after treatment(P<0.05).No significant differences were found in pre-treatment thyroid function between the two groups(P>0.05).Conclusion:The application of TSH inhibition therapy in the postoperative management of patients with differentiated thyroid cancer demonstrates promising outcomes.
基金supported by the National Natural Science Foundation of China(No.51603030)Strategic Cooperation Program of Sichuan University and Luzhou Municipal People’s Government(No.2018CDLZ-06).
文摘Endoscopic submucosal dissection(ESD)has been clinically proved to have prominent advantages in the treatment of early gastrointestinal cancers over traditional surgery,including less trauma,fewer complications,a quicker recovery and lower costs.During the procedure of ESD,appropriate and multifunctional submucosal injected materials(SIMs)as submucosal cushions play an important role,however,even with many advances in design strategies of SIMs over the past decades,the performance of the submucosal cushions with postoperative management function seems to be still unsatisfactory.In this review,we gave a brief historical recount about the clinical development of SIMs,then some common applications of hydrogels used as SIMs in ESD were summarized,while an account of the universal challenges during ESD procedure was also outlined.Going one step further,some cutting-edge functional strategies of hydrogels for novel applications in ESD were exhibited.Finally,we concluded the advantages of hydrogels as SIMs for ESD as well as the treatment dilemma clinicians faced when it comes to deeply infiltrated lesions,some technical perspectives about linking the clinical demand with commercial supply were also proposed.Encompassing the basic elements of SIMs used in ESD surgery and the corresponding postoperative management requirements,this review could be a good reference for relevant practitioners in expanding the research horizon and improving the well-being index of patients.
文摘Objective:This study was designed to determine the nurse assessment of postoperative pain and its management in selected hospitals,Benin City,Edo State,Nigeria.Materials and Methods:A descriptive cross-sectional survey was adopted.The target population consist of 222 purposely nurses who are in the cadre of nursing officer II to chief nursing officer who works in the various surgical wards/units of the selected health facilities.The data were collected from the participants using the pretested structured questionnaire developed by the researcher.Results:Results showed that 66.2%of nurses had a poor level of knowledge on postoperative pain assessment.The McGill Pain Questionnaire was the most used pain assessment tool with a mean score of 2.84 whereas the Dallas Pain Questionnaire was the least used with a mean score of 1.90.“Providing clean,calm,and well-ventilated ward environment”(3.69±0.61)was the most used nonpharmacological method for postoperative pain management,followed by“distraction,relaxation,and guided imagery”(3.52±0.50),“dressing,bandage,splint,and reinforce wound sites postoperatively”(3.39±0.54),and“early ambulation/exercise”(3.20±0.62).The most used pharmacological interventions were“acetaminophen”(3.63±0.55),“topical anesthetic”(2.92±0.62),“nonselective nonsteroidal anti-inflammatory drugs”(2.87±0.43),and“mixed opioid agonist-antagonist”(2.56±0.56).Conclusion:There is a poor level of knowledge on postoperative pain assessment among nurses in this study setting.It is,therefore,pertinent for hospitals to organize continuous in-service training for postoperative pain assessment and management,especially on nonpharmacological approaches among nurses.
文摘Total knee replacement,a common surgery among the elderly primarily necessitated by osteoarthritis,replaces the damaged knee joint with an artificial one.Given the aging population and the increasing prevalence of such surgeries,the article highlights the critical need for effective postoperative care strategies.This editorial provides an overview of rehabilitation care for pain in elderly knee replacement patients,emphasizing the importance of a multimodal approach to postoperative recovery.Furthermore,the article advocates for a patient-centered,comprehensive rehabilitation regimen that enhances recovery and quality of life in elderly patients undergoing knee replacement surgery.
基金supported by the National Science and Technology Infrastructure Program of the twelfth five-yearplan period(No:2011BAI11B22)
文摘Anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA） is a rare congenital anomaly It demonstrated the combined effects of the absence of a normal coronary flow with a coronary steal and the profound ischemia that can produce left ventricular dysfunction and mitral regurgitation. We here introduce the postoperative management of patients with repair of anomalous ori artery from the pulmonary artery, with an emphasis on its outcome. Methods Reco gin rds of the left coronary of 31 patients with anomalous origin of the left coronary artery from the pulmonary artery receiving surgery from 1998 to 2010 were reviewed retrospectively, 10 of which were treated with the mitral valve surgically at the same time. The age of patients was 4 months to 16 years （m kilograms）, all of which were diagno edian, sed of anomalous origin of the left coronary artery from the pulmonary by echocardiography and cardiac catheterization. After surgery, electrocardiogram, echocardiography, arterial blood pressure, transcutaneous oxygen saturation and central venous pressure were monitored. Common postoperative complications in our group were analysed. And preoperative and postoperative data including area of mitral regurgitation, left ventricular systolic diameter and left ventricular distolic diameter were obtained. Cardiopulmonary bypass time and mechanical ventilation time of postoperative patients with no pneumonia were compared with those with pneumonia. Binary logistic regression was applied for the analysis of the risk factors of postoperative pneumonia. Results Of 31 patients, 30 survived after surgery with early mortality of 3.23%. One patient died of severe low cardiac output syndrome. Mechanical ventilation time was 4 hours to 168 hours hours （mean, 39.68 ± 50.52 hours; median, 18 hours）. ICU stay was 16 hours to 425 hours （mean, 111.65 ± 127.03 hours; median, 44 hours）. In our group, common postoperative complications were myocardial ischemia（n = 12, 36.4%）, infection（n = 11, 33.3%） including pneumonia （n = 10, 30.3%）, postoperative tachyarrhythmia（n = 5, 15.2%）, low postoperative cardiac output（n = 2, 6.1%）, endocarditis（n = 1, 3.0%）. Compared with preop-erative data, postoperative data including area of mitral regurgitation, left ventricular systolic diameter and left ventricular distolic diameter decreased remarkably（P 〈 0.01）, with left ventricular ejection fraction significantly improved （P 〈 0.05）. Compared with mechanical ventilation time of patients with no postoperative pneumonia, time of those with pneumonia apparently prolonged（P 〈 0.01 ） while cardiopulmonary bypass time extended （P 〈 0.05）. Mechanical ventilation time was a risk factor of postoperative pneumonia （OR = 1.041, OR 95%CI = （1.010, 1.073）. Conclusions Proper therapy strategies according to the knowledge of the ALCAPA disease and the change of postoperative pathology and physiology play an important role in avoiding the postoperative complications and improving postoperative outcomes.
基金the National Key R&D Program of Reproductive Health and Women's and Children's Health Assurance Special Fund,No.2022YFC2704004.
文摘BACKGROUND Currently,the use of dienogest in clinical practice has increased significantly,and many studies have focused on its effectiveness and safety in the treatment of endometriosis and adenomyosis;however,the effects of treatment with dienogest on uterine fibroid size in patients with endometriosis or adenomyosis have not been investigated.AIM To explore changes in fibroid size in patients with concomitant uterine fibroids undergoing dienogest treatment for endometriosis or adenomyosis and to evaluate the effectiveness and safety of the drug.METHODS The clinical data of patients with uterine fibroids treated with dienogest for endometriosis or adenomyosis at Peking University First Hospital from January 2021 to January 2023 were retrospectively analyzed.RESULTS The maximum uterine fibroid diameter and volume increased after 3 months,6 months and 1 year of dienogest treatment compared with those before treatment(P<0.01).The maximum diameter and volume of the uterine adenomyoma increased after 3 months of dienogest treatment but decreased after 6 months and 1 year of treatment compared with those before treatment,but the difference was not significant(P>0.05).Endometrial thickness and antigen 125 levels were significantly thinner and decreased,respectively,after dienogest treatment(P<0.01).Pearson's correlation analysis revealed that the increase in uterine fibroid volume after 3 months of dienogest treatment was positively correlated with the basic uterine fibroid volume(r=0.792,P<0.01).Among 64 patients with dysmenorrhea,63 experienced significant relief of dysmenorrhea after 6 months of treatment with dienogest,and all patients experienced significant relief of dysmenorrhea after 12 months.Patients were able to tolerate the drugs,with an average drug tolerance score of 8.73.CONCLUSION The use of dienogest in patients with endometriosis or adenomyosis combined with uterine fibroids can effectively relieve the patient's pain symptoms and significantly reduce the sizes of ovarian endometriotic cysts,but it cannot inhibit uterine fibroid growth.
基金Jiaxing Key Discipline of Medicine-Oncology(Supporting Subject),No.2019-zc-11.
文摘BACKGROUND Coronavirus disease 19(COVID-19)is a global pandemic and has had a profound impact on our routine surgical activities.Acute appendicitis is the most common abdominal emergency worldwide.Therefore,it is highly essential to assess the influence the pandemic has on acute appendicitis.AIM To assess the efficacy of the management of acute appendicitis during the COVID-19 pandemic.METHODS We retrospectively analyzed 90 patients who presented with acute appendicitis during the outbreak of COVID-19 in Jiaxing,China.Clinical data regarding appendectomies patients were also collected for the corresponding time frame from 2019.Preoperative management,intraoperative protective measures,and postoperative management were conducted.RESULTS After screening,six patients were identified as unqualified due to fever and were then referred to the COVID-19 expert group.The results of the nucleic acid test were negative.Of the 76 patients enrolled in the simple group,nine patients received medication therapy,and all others underwent surgery.From this same group,66 patients were diagnosed with suppurative appendicitis,and one patient was diagnosed with perforated appendicitis after surgery.There were 14 patients in the complex group,for which the postoperative diagnosis indicated perforated appendicitis.The proportion of men with perforated appendicitis was higher than that in 2019(P<0.05).The chief complaint duration for perforated appendicitis patients in 2020 was longer than that in 2019(P<0.05).The routine blood test showed that white blood cell counts and neutrophil ratios were higher in perforated appendicitis patients in 2020 than in 2019(P<0.05).The ratio of open appendectomies to the amount of mean blood loss during surgery was greater in 2020 than in 2019(P<0.05).Online consultation after discharge was selected in 59 cases(65.6%).No perioperative infection with COVID-19 or long-term postoperative complications were found.CONCLUSION The management of acute appendicitis from Jiaxing effectively reduced the influence of the pandemic and minimized the risk of nosocomial infection.
基金supported by the National High Level Hospital Clinical Research Funding(Nos.2022-PUMCH-B-006 and 2022-PUMCH-C-067)the National Natural Science Foundation of China(No.32271391)Beijing Natural Science Foundation(No.Z220022).
文摘Besides peripheral nerve injury,the acute inflammation is one of the pathological features of tissues after surgery,which exacerbates the postoperative pain,especially in the first 48 h after the surgery.Multimodal analgesia(MMA),such as the combination of non-steroidal anti-inflammatory drugs(NSAIDs)with local anesthetics,has shown enhanced potency compared with the usage of local anesthetics alone.However,rare formulations can provide long-term analgesia at a single dose.Herein,bupivacaine(BUP,a local anesthetic)loading poly(lactic-co-glycolic acid)(PLGA)nanoparticles(NPB)were coated with meloxicam(MLX,an NSAID)loading lipid bilayer(LPM),forming a core–shell nanosystem(NPB@LPM)to provide enhanced and long-term analgesia to treat postoperative pain.MLX was encapsulated in the lipid shell,which enabled high dose MLX to be released in the first 48 h after surgery to reduce the acute inflammation induced pain.BUP was encapsulated in the PLGA core to provide a long-term release for the nerve block.This nanosystem provided a 7-day(whole recovery cycle)effective analgesia in the Brennan’s plantar incision rat model.The tissue reactions of NPB@LPM are benign.This work will provide feasible strategies on designing drug delivery systems for postoperative pain management.
文摘Rib cartilage is the most reliable material for structural support and dorsal augmentation in Asian rhinoplasty with its robust strength and bountiful amount. Its value is incomparable especially in complex, cartilage-depleted revision surgery or major reconstruction. There are many articles regarding harvesting and carving of rib cartilage in rhinoplasty,however, only few has focused on preoperative and postoperative issues. Preoperatively, evaluating cartilage availability, assessing quality and quantity of cartilage, and choosing the cartilage to harvest are necessary. Although easily overlooked, proper postoperative management of rib cartilage rhinoplasty patients is key to prevent infection and heighten patient satisfaction. Here in, I would like to introduce how I evaluate rib cartilage rhinoplasty patients preoperatively and manage them postoperatively to maximize the surgical results.
文摘To investigate best diagnosing methods and therapy for patients with biliary tract complications after liver transplantation and analyze related factors Methods A review was made of data collected from 96 patients, and confirmed by retrospective case notes examination Results A total of 94 patients (97 grafts) survived more than 2 days after transplantation; of whom, 92 had an end to end biliary anastomosis with a T tube The average follow up was 5 8 months (range: 0 3-10 2 months) Among the 94 patients, eight (8 5%, 8/94) had complications: leakage during T tube removal (2 patients), leakage at an earlier stage (2), simultaneous stricture and leak (2) and just stricture (2) Six patients with biliary tract complications had predisposing factors including hepatic artery stenosis (2 patients, including one hepatic artery stenosis combined with severe rejection, hepatic artery thrombosis (3), and donor recipient bile duct mismatch (1) There was no difference in cold ischemic time With hepatic artery thrombosis and/or stenosis 】50%, five patients were re transplanted; without hepatic artery thrombosis and/or stenosis 【50%, three patients required endoscopic stenting and radiological percutaneous drainage of bile collection with or without balloon dilation All patients survived Conclusions Biliary strictures occur later than leaks after surgery Without hepatic artery thrombosis and/or stricture, there is no need for surgery; with hepatic artery thrombosis and/or stricture 】50%, re transplantation is needed as early as possible
基金Supported by Guangdong Provincial Department of Science and Technology(No:2015A020210061)
文摘Patients who undertake cardiac surgery usually manifest discomforts. Comfort care plays an im- portant role in the postoperative management of a cardiac surgery patient. Methods A self-made General Com- fort Scale was used to evaluate the discomfort factors of 156 adult patients who underwent cardiac surgery in our department of Guangdong General Hospital from January to April 2014. All patients had open chest cardiac sur- gery under general anesthesia and cardiopulmonary bypass. The reasons for the discomfort were collected and the appropriate comfort cares were implemented. Results Our data showed that the main factors influencing the comfort of surgical patients included pain, thirst, hunger, nausea, vomit, abdominal distension, sleeping disorder, postural discomfort, surrounding and psychological causes etc. Among the 156 adult patients, 153 patients com- plained of thirst, 141 patients felt painful, 96 patients felt hungry, and 67 patients had sleeping disorders. These discomfort factors affected the treatment and rehabilitation of patients. Conclusions Basic and specific comfort and appropriate nursing cares should be carried out to alleviate the discomfort factors such as sleep disorder, pain and endotracheal intubation, which could protect patients＇ benefit and promote their rehabilitation.
