To analyze the complications of temporary abdominal aortic balloon occlusion in pelvic tumor resection surgery and the risk factors affecting the occurrence of severe complications.
Methods
Pelvic tumor patients who underwent surgery at the Department of Retroperitoneal Tumor Surgery, Peking University International Hospital from January 2014 to June 2024 were collected.All the patients used the temporary abdominal aortic occlusion balloon during the operation. According to the severity of postoperative complications (based on the Clavien-Dindo classification), the patients were divided into a severe complication group (complications≥grade 3) and a non-severe complication group (no complications or complications≤grade 2). The occurrence of postoperative complications in all patients was statistically analyzed, and by comparing the differences in clinical and pathological data between the two groups, the possible risk factors related to the occurrence of severe complications were explored.
Results
A total of 25 patients were included, of which 21 achieved R0/R1 resection. A total of 6 patients experienced severe complications (≥grade 3) (24%), all of whom recovered and were discharged after treatment, with no perioperative deaths. There were no significant differences between patients with severe complications and those without in terms of gender, age, tumor status, combined organ resection, intraoperative bleeding and transfusion volume, operation time, number of occlusions, or postoperative hospital stay (P＞0.05). The cumulative occlusion time (P=0.001) and the longest single occlusion time (P=0.032) were longer in the group with severe complications.
Conclusion
Prolonged occlusion time and longer single occlusion time may be risk factors for severe complications after the use of temporary abdominal aortic occlusion balloon in pelvic tumor resection surgery. By reducing intraoperative occlusion time, it is possible to reduce the occurrence of severe postoperative complications while minimizing bleeding.
To explore the prevention and management of hemorrhage risks during resection of pelvic retroperitoneal tumor involving major blood vessels, and to summarize the experience in managing retroperitoneal pelvic tumors involving major blood vessels.
Methods
A retrospective analysis was conducted on the clinical data of 27 patients with pelvic retroperitoneal tumor involving major vessels(including the abdominal aorta, inferior vena cava, iliac vessels, and mesenteric arteries and veins) who were treated at Guangdong Provincial Hospital of Traditional Chinese Medicine between January 2020 and May 2024. The data included general clinical information (such as patient age, gender, body mass index, history of previous abdominal surgery, and whether the tumor was primary or recurrent), surgery-related information(ASA classification, operative time, postoperative hospital stay, and major postoperative complications),data related to hemorrhage prevention and management (preoperative strategies to mitigate bleeding risks,intraoperative transfusion of blood products and transfusion volume, and management of major vessels involved by the tumor), and three-dimensional reconstruction images.
Results
Among the 27 patients with pelvic retroperitoneal tumor involving major blood vessels, there were 13 males and 14 females, with a median age of 64.0 (51.0, 68.0) years. The median maximum tumor diameter was 10.5 (6.5, 20.0) cm, with 15 cases (55.6%) being primary tumors and 12 (44.4%) being recurrent tumors. The average preoperative hemoglobin level was 112.9±3.7 g/L. In terms of vascular involvement, the abdominal aorta was involved in 5 cases (18.5%), inferior vena cava in 2 (7.4%), iliac artery in 6 (22.2%), iliac vein in 2 (7.4%), both iliac artery and vein in 2 (7.4%), splenic artery in 1 (3.7%), left renal vein in 1 (3.7%), both left renal artery and vein in 1 (3.7%), inferior mesenteric arteries and veins in 1 (3.7%), both inferior vena cava and iliac artery in 2 (7.4%), both inferior vena cava and right renal vein in 1 (3.7%), both inferior vena cava and left common iliac artery in 1 (3.7%), both left gastroepiploic vein and left renal vein in 1 (3.7%), and superior rectal artery in 1 (3.7%). Depending on the specific circumstances, treatment strategies included blunt dissection,intermittent vascular occlusion and suspension, vascular ligation, or combined organ resection, all of which successfully achieved complete tumor resection. The median intraoperative blood loss was 300.0 (100.0,700.0) ml, and 10 patients (37.0%) required intraoperative blood transfusions, mainly red blood cells and fresh frozen plasma. Postoperatively, 8 patients (29.6%) were admitted to the intensive care unit, and the median postoperative hospital stay was 15.0 (12.0, 25.0) days. The most common pathological type was liposarcoma, accounting for 9 cases (33.3%).
Conclusion
For resection of pelvic retroperitoneal tumor involving major blood vessels, it is crucial to prepare sufficient blood products preoperatively and formulate comprehensive surgical plans. In addition to preparing for vascular replacement, preoperative placement of vascular occlusion bands before tumor dissection is essential to prevent sudden massive hemorrhage from major vessels. Full attention should be given to effective prevention and control of bleeding risks.
Early and accurate assessment of infarct core and ischemic penumbra volume is crucial for treatment decisions in acute ischemic stroke (AIS). This study aimed to compare the accuracy and consistency of multi-delay arterial spin labeling (ASL) and computed tomography perfusion(CTP) in evaluating the volumes of these lesion.
Methods
A retrospective analysis was conducted on 36 AIS patients who were admitted to Xuanwu Hospital of Capital Medical University between July 2021 and September 2023. All patients underwent both multi-delay ASL and CTP scans (with an interval of＜24 hours between the two examinations). The ASL and CTP images were analyzed, and the differences in infarct core and ischemic penumbra volumes measured by the two modalities were compared using the Wilcoxon signedrank test. Intraclass correlation coefficient (ICC) was used to assess the consistency of the two methods in measuring these volumes.
Results
The infarct core volumes measured by multi-delay ASL (12.56 [7.99,37.59]) and CTP (10.50 [6.00, 37.00]) showed no statistically significant difference (P＞0.05). Similarly,the ischemic penumbra volumes measured by multi-delay ASL (124.94 [94.67, 150.16]) and CTP (116.00[83.00, 151.00]) also showed no significant difference (P＞0.05). The ICC for measuring infarct core and ischemic penumbra volumes by the two methods were 0.967 and 0.949, respectively, indicating a high level of consistency.
Conclusion
Both multi-delay ASL and CTP demonstrate high diagnostic accuracy and good consistency in evaluating infarct core and ischemic penumbra volumes in AIS patients. Multi-delay ASL is a promising imaging method with potential for clinical application and further exploration.
To explore the effect of high volume hemofltration (HVHF) combined with continuous plasma filtration absorption (CPFA) on inflammatory response and respiratory function in patients with sepsis-associated acute respiratory distress syndrome (ARDS).
Methods
Sixty patients with sepsis complicated by ARDS, treated in the Department of Critical Care Medicine of the Third Hospital of Hebei Medical University, were randomly divided into an HVHF group and an HVHF+CPFA group, which received standard HVHF treatment and HVHF combined with HA380 hemoperfusion, respectively. The general patient data, including age, sex, sequential organ failure assessment (SOFA) score, acute physiology and chronic health status evaluation (APACHE Ⅱ) score, vital signs (such as heart rate [HR] and respiratory rate [RR]),procalcitonin (PCT), lactic acid (Lac), and total bilirubin (TBil), were compared between the two groups.The main study outcomes [white blood cell count (WBC), serum interleukin 6 (IL-6), carbon dioxide partial pressure (PCO2), oxygenation index (PaO2/FiO2), aspartate aminotransferase (AST), alanine aminotransferase(ALT), and mechanical power (MP)] and secondary study outcomes [mean arterial pressure (MAP), central venous pressure (CVP), platelet count (PLT), prognostic indicators (ICU mortality and ICU stay)] were compared between the two groups before and 12 h and 24 h after treatment.
Results
A total of 60 patients were enrolled, with 30 in the HVHF group and 30 in the HVHF+CHVHF group, most of whom were male(70%). There were no statistically significant differences between the two groups in terms of gender, age,pre-treatment SOFA score, HR, MAP, RR, MP, WBC, PCT, Lac, TBiL, IL-6, PLT, AST, ALT, CVP, PCO2,and PaO2/FiO2 (P＞0.05). Compared with the HVHF group, the serum IL-6 levels in the HVHF+ CHVHF group showed a downward trend at 24 and 48 hours after treatment, as well as a decreasing trend in PLT and MP at 48 hours after treatment, with statistically significant differences between the two groups (P＜0.05).No statistically significant differences were observed between the two groups in other parameters (P＞0.05).Generalized estimating equation (GEE) analysis showed that treatment modality, APACHE II score, WBC,and time were factors influencing MP, and treatment modality and time were factors influencing IL-6 after controlling for other factors (gender, age, pre-treatment SOFA score, HR, MAP, RR, PCT, Lac, TBiL, PLT,AST, ALT, CVP, PCO2, and PaO2/FiO2).
Conclusion
HVHF combined with CPFA is an effective means of treating patients with sepsis complicated by ARDS, as it effectively clears IL-6 and reduces MP.
To compare and analyze the sedation effect of applying remimazolam benzenesulfonate and propofol during rescue tracheal intubation in neurocritical patients.
Methods
A total of 114 neurocritical patients admitted to Wuhan Fourth Hospital from February 2024 to November 2024 were selected and divided into either a remimaazolam group (Group R; 57 cases) or propofol group (Group P;57 cases) according to the the sedative drug used, and the changes of vital signs, sedation effect, intubation evaluation, and the incidence of adverse reactions in the two groups were compared.
Results
Hemodynamic fluctuations during intubation were significantly smaller in the remimazolam group than in the propofol group(P＜0.05). The overall incidence of adverse reactions in the remimazolam group was 31.6%, which was significantly smaller than that of the propofol group (68.4%; P＜0.05). There was no significant difference in the success rate of first-dose sedation or the success rate of first intubation between the two groups. The time to loss of consciousness [(63.60±14.02)s vs (46.61±13.28)s, P＜0.05)] and intubation time [(37.44±11.18)s vs (33.02±8.14)s, P=0.017)] in the remazolam group were longer than those of the propofol group (P＜0.05),but no significant difference was seen in any of the choking body movements between the 2 groups(P＞0.05).
Conclusion
Remimazolam benzenesulfonate has the characteristics of fast onset of action,no injection pain, and not being easy to cause respiratory depression, and can provide similar intubation conditions as propofol with less hemodynamic impact, representing some advantages in rescue tracheal intubation in neurocritical patients.
To explore the correlation of serum uric acid (SUA) and serum uric acid/creatinine (SUA/SCr) ratio with metabolic associated fatty liver disease (MAFLD) in young men, and to compare the value of the two in the preliminary screening of MAFLD.
Methods
Demographic data,laboratory results, and imaging data of young males from the physical examination population were collected.The research subjects were divided into Q1～Q4 groups and Q1’～Q4’ groups according to the quartiles of SUA and SUA/SCr ratio, respectively.
Results
A total of 419 subjects were included (147 in MAFLD group and 272 in non-MAFLD group). The MAFLD group had higher age (36 years vs 35 years, P＜0.01), body mass index (BMI; 27.05 vs 24.19, P＜0.001), systolic blood pressure (128.11 mmHg vs 121.26 mmHg,P＜0.001), diastolic blood pressure (77.13 mmHg vs 72.82 mmHg, P＜0.001), fasting blood glucose (5.36 mmol/L vs 5.15 mmol/L, P＜0.001), triglycerides (1.75 mmol/L vs 1.10 mmol/L, P＜0.001), and eGFR(115.44 ml/min vs 102.81 ml/min, P＜0.001) levels, but a lower high-density lipoprotein (1.39 mmol/L vs 1.54 mmol/L, P＜0.001) level than the non-MAFLD group. There were statistically significant differences in SUA and SUA/Scr between the two groups. In the Q1～Q4 group divided by SUA, the positive rate of MAFLD accounted for 12.9%, 25.2%, 25.9%, and 36.1% of all MAFLD cases, respectively (χ2=24.98, P＜0.001). In the Q1’～Q4’ group divided by SUA/SCr ratio, the positive rate of MAFLD was 12.9%, 22.4%, 29.9%, and 34.7%, respectively (χ2=25.60, P＜0.001). After adjusting for age, SBP, DBP, BMI, HDL-C, LDL-C, TG,FBG, etc., the risk of MAFLD in the Q4 group was 2.28 times that of the Q1 group (P=0.04), and the risk of MAFLD in the Q4’ group was still 2.94 times that of the Q1’ group (P=0.007). There was no significant difference in the area under the ROC curve between SUA (0.655) and SUA/SCr ratio (0.663) for screening for MAFLD.
Conclusion
SUA and SUA/SCr ratio are both risk factors for MAFLD. The screening value of SUA/SCr ratio for MAFLD is not superior to that of SUA in young men.
To explore the composition of urinary tract stones and analyze their correlation with clinical characteristics, so as to provide scientific basis and precise strategic guidance for effective prevention and treatment of urinary tract stones.
Methods
A total of 410 patients with urinary tract stones who have been living in Xiaodian District, Taiyuan, Shanxi Province for a long time and treated at Peking University First Hospital Taiyuan Hospital from December 2022 to August 2024 were included as the observation group, and 410 healthy individuals who underwent physical examination during the same period were included as the control group. The general information such as age, gender, body mass index(BMI), and daily water intake was compared between 2 groups. Infrared spectroscopy was used to detect the chemical composition of urinary stones in the observation group. Multiple logistic regression analysis was conducted to identify the risk factors for urinary stones. Data from both stone patients and non-stone patients were collected for analysis of influencing factors of 24-hour urinary stone formation.
Results
The contents of citric acid, potassium, and magnesium in the observation group were significantly lower than those of the control group, while the concentrations of oxalic acid, uric acid, calcium, and phosphorus were significantly higher than those of the control group (P＜0.05). Calcium oxalate and carbonate apatite had the highest detection rates, while uric acid, magnesium ammonium phosphate, and calcium hydrogen phosphate had relatively lower detection rates. Multivariate logistic regression analysis showed that BMI, diet with wholesheep soup, daily water intake＜1 L, frequent alcohol consumption, and lack of exercise were independent risk factors for urinary tract stones (P＜0.05). The citric acid level in the stone group was significantly lower than that of the non-stone group, and the potassium content was significantly higher than that of the non-stone group (P＜0.05), indicating that low citric acid and high potassium are independent influencing factors for 24-hour urinary stone formation.
Conclusions
The chemical component of urinary tract stones in patients with urinary tract stones in Xiaodian District, Taiyuan, Shanxi is mainly calcium oxalate, which is more common in the upper urinary tract. Low citric acid and high potassium are independent factors affecting 24-hour urinary stone formation. The occurrence of urinary tract stones is related to various factors such as high BMI, low water intake, diet with whole-sheep soup, and insufficient exercise. Early preventive intervention measures are beneficial for the treatment guidance and prevention of urinary tract stones.
To comprehensively investigate the awareness of and willingness to use digital therapeutics (DTx) among orthopedic rehabilitation medical staff, analyze the possible problems in its use, and provide decision-making basis for the development and application of DTx.
Methods
An observational cross-sectional study was used to investigate the awareness of and willingness to use DTx among orthopedic rehabilitation medical staff in four public medical institutions in Beijing via a questionnaire survey, and the results were statistically analyzed.
Results
A total of 381 valid questionnaires were collected, and it was found through statistical analysis that orthopedic rehabilitation medical staff had a relatively low level of awareness of DTx, and there were differences in the level of awareness among orthopedic rehabilitation medical staff with different positions. Orthopaedic rehabilitation therapists were more aware of DTx than orthopaedic nurses and physicians. Most medical staff were optimistic about DTx,and they believed that DTx could improve work efficiency and provide more convenient and flexible health management methods for patients, and were willing to use DTx to manage patients. However, only 21% of participants had used DTx. In addition, 60.89% of participants were concerned about privacy and security issues, 43.83% were concerned about weakening interpersonal relationships with patients, 46.72% were concerned about taking up free time, and only 41.99% were willing to spend more than 30 minutes per day on DTx.
Conclusion
Although most orthopedic rehabilitation medical staff had low awareness and utilization of DTx, and there were differences in the level of awareness of DTx among orthopedic rehabilitation medical staff with different positions, they expressed their support and willingness to try the new rehabilitation mode of orthopedic rehabilitation DTx. Therefore, targeted training and promotion for medical staff with different positions may help to improve their awareness and usage of DTx.
To examine the association between self-reported smoking status and serum levels of cotinine, a nicotine metabolite commonly used as a marker of tobacco exposure, and constipation among US adults to provide a scientific basis for constipation prevention and treatment.
Methods
Data were obtained from cross-sectional studies conducted by the Centers for Disease Control and Prevention (CDC)in the U.S. Data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010 were used in this study. The t-test, Mann-Whitney U-test, and χ2 test were performed using R and Windrush statistical software. Three sequential multivariate logistic regression models were used to investigate the relationship between tobacco exposure and the incidence of constipation, and dose-response curves between serum cotinine levels and the risk of constipation were assessed using restricted cubic spline (RCS) regression.Subgroup analyses were stratified according to relevant confounders such as sex, age, body mass index (BMI),and presence of diabetes.
Results
A total of 11651 participants were included in this cross-sectional study.The mean age of the study participants was 48.8 ± 17.9 years. Multivariate regression analyses showed that self-reported smoking status was not significantly associated with the risk of constipation after controlling for covariates, but continuous and categorical analyses with reference to the lowest serum cotinine level (＜0.05 ng/ml) resulted in a 36% higher prevalence of constipation among participants with a serum cotinine level of between 0.05 and 2.99 ng/ml (Model 1: odds ratio [OR]=1.45 [1.13～1.85]; Model 2: OR=1.44 [1.12～1.83];Model 3: OR=1.36 [1.06～1.74]; P＜0.05). In the non-smoking population, serum cotinine levels were linearly and positively associated with the risk of constipation (Pnonlinear＞0.05), and the relationship between smoke exposure and constipation was relatively stable in each subgroup.
Conclusion
The promotional effect of serum cotinine levels on constipation occurs in non-smokers; therefore, avoiding passive smoking as much as possible may attenuate the effect of smoke exposure on constipation and prevent and treat constipation.
To systematically retrieve the evidence of phase I exercise rehabilitation in patients with left ventricular assist device implantation and provide scientific exercise methods.
Methods
A computer-based search of BMJ Best Practice, UpToDate, the Australian Joanna Briggs Institute Evidencebased Healthcare Center Database, the Cochrane Library, the British National Institute of Health and Clinical Optimization, Web of Science, PubMed, China Knowledge Network, Wanfang Database, and other databases for clinical decision-making, guidelines, expert consensus, systematic evaluation, and evidence summary related to phase I exercise rehabilitation after left ventricular assist device implantation. The retrieval time limit is from the inception of the databases to May 2024. Two researchers evaluated the quality of the literature and extracted and summarized the evidence.
Results
A total of 12 articles were included,including 1 clinical decision, 2 guidelines, 4 expert consensuses, and 5 systematic reviews. A total of 21 lines of evidence were summarized, which were divided into five aspects:multidisciplinary participation, prerehabilitation evaluation, exercise type and intensity, exercise ability evaluation, and exercise precautions and safety management.
Conclusion
This study summarized the best evidence for phase I exercise rehabilitation in patients with left ventricular assist device. Medical staff should combine clinical practice and patient conditions to construct an exercise rehabilitation program for patients during hospitalization to promote the implementation of phase I cardiac rehabilitation after surgery.
Immune checkpoint inhibitors (ICIs) have achieved a milestone breakthrough in the field of advanced cancer treatment, greatly improving the overall prognosis of these patients. However, due to their potential to lead to the recurrence or exacerbation of autoimmune diseases (AIDs), almost all clinical trials involving ICIs have excluded malignant tumor patients with concurrent AIDs. Can patients in this specific group attempt ICI treatment? What are the risks and benefits of this treatment? This article will systematically summarize the current application status, challenges, and prospects of ICIs in tumor patients with pre-existing AIDs, aiming to provide comprehensive guidance for the use of ICIs in this special population to achieve favourable therapeutic effects.
Remote ischemic preconditioning (RIPC) refers to the method of implementing transient ischemia-reperfusion in the distal limb to human vital organs to protect organs. Although its effectiveness and safety in the protection of vital organs have been confirmed in some clinical studies and animal experiments,its clinical effect is still controversial. The protective effect of RIPC weakens with age. Therefore, it is necessary to further study the correlation between RIPC and age as well as the underlying mechanism to better understand its potential therapeutic application prospects and provide an important basis for clinical transformation. This article reviews the age-related differences and potential therapeutic prospects of remote ischemic preconditioning based on animal experiments and clinical trials.
Acute respiratory distress syndrome (ARDS) represents a crucial disease within the domain of critical care medicine, featuring a relatively high incidence and mortality rate among the population.Subsequent to the outbreak of the Coronavirus Disease 2019 epidemic, extensive research on ARDS has been carried out. Despite the advancement in the understanding of this disease, numerous clinical studies on the treatment of ARDS have failed to achieve the anticipated success. This is due to the heterogeneity of ARDS in multiple aspects, this is, it has different phenotypes, which renders single, standardized treatments ineffective in improving the prognosis for all patients. Therefore, if the phenotypes of ARDS can be identified rapidly and accurately, and patients are subdivided into more homogeneous subgroups based on the different phenotypes followed by precise and individualized treatment, favorable feedback should be achievable. Lung ultrasound(LUS) has been widely applied in the diagnosis and treatment of ARDS patients, providing a potent tool for the identification of ARDS phenotypes. This paper aims to expound on the application progress of pulmonary ultrasound in the identification of ARDS phenotypes, assisting clinicians in formulating individualized treatment plans and enhancing patient prognosis.
