Objective To explore the correlations between nutritional markers and pressure injury (PI) in elderly patients with chronic obstructive pulmonary disease (COPD). Methods Retrospective analysis was conducted on elderly patients with COPD and PI who were admitted to the geriatric department of West China Hospital of Sichuan University or Dujiangyan People’s Hospital between January 2020 and December 2021. The blood biochemical indicators mainly including nutritional markers were collected, and their correlations with PI risk factor index Braden score and PI severity index PI stage were analyzed. Results A total of 293 patients with COPD and PI were included. Among the five Braden score groups, the differences in the levels of albumin and prealbumin were statistically significant (P<0.05), and the Braden score was positively correlated with albumin (rs=0.241, P<0.001), prealbumin (rs=0.179, P=0.002), and hemoglobin (rs=0.199, P=0.001). Among the six PI stage groups, the differences in the levels of albumin, globulin, red blood cell count, serum sodium, blood chloride and C-reactive protein were statistically significant (P<0.05), and the PI stage was negatively correlated with albumin (rs=−0.192, P=0.001), and positively correlated with serum sodium (rs=0.139, P<0.001), blood chloride (rs=0.184, P<0.001), and C-reactive protein (rs=0.177, P=0.020). Conclusion When PI risk assessment and severity assessment are performed on elderly COPD patients, it is necessary to pay more attention to nutritional markers and assess whether the patients are at risk of protein malnutrition, which will help to improve the accuracy of PI risk assessment and severity prediction, and effectively improve the efficacy of PI prevention and treatment.
Objective To explore the retinal and choroidal thickness of myopic patients with different diopters, and analyze the change rule and its relation with the diopter. Methods From October 2015 to June 2016, a total of 161 patients (322 eyes) with myopia and 53 normal volunteers (106 eyes) were selected from Department of Ophthalmology, West China Hospital of Sichuan University. Optical coherence tomography (OCT) examination was performed in all the subjects with Macular cube 512×128 and EDI HD-OCT model in Cirrus HD-OCT 5000 of Carl Zeiss Company from Germany, measuring the retinal and choroidal thickness in macular central fovea, and 3 and 6 mm above, below, on the nose side, and on the temporal side of macular central fovea; the data were averaged. According to the different diopters, the subjects were divided into four groups, including emmetropia group with 53 patients (106 eyes), low myopia group (equivalent diopter from –0.25 to –3.00) with 64 patients (128 eyes), moderate myopia group (equivalent diopter from –3.25 to –6.00) with 47 patients (94 eyes), and high myopia group (equivalent diopter <–6.00) with 50 patients (100 eyes). All the subjects’ best corrected visual acuities were ≥0.8. The changes of retinal and choroidal thickness in myopia patients with different diopters were compared and analyzed. Results The average retinal thickness of the patients in the emmetropia group, the low myopia group, the moderate myopia group, and the high myopia group was (242.50±29.86), (238.46±23.85), (224.52±26.01), (211.91±23.07) μm, respectively; the average choroidal thickness of the patients in the emmetropia group, the low myopia group, the moderate myopia group, and the high myopia group was (220.16±66.00), (252.39±79.56), (191.09±103.03), (121.83±92.54) μm, respectively. There was no significant difference in retinal thickness between the moderate myopia group and the high myopia group (P>0.05), while the differences in retinal thickness between the remaining groups were statistically significant (P<0.05); there was no statistically significant difference between the emmetropia group and moderate myopia group (P>0.05), while the differences in choroid thickness between the remaining groups were statistically significant (P<0.05). Conclusion In general, there are decreasing trends of the retinal thickness and choroid thickness with the increase of the diopter, which may be associated with the formation process of myopia.
目的 探讨音乐疗法在儿童青少年情绪障碍患者中的应用效果。 方法 2011年1月－7月，将70例儿童青少年情绪障碍患者随机分为试验组和对照组，每组各35例，对照组给予常规药物治疗和护理，试验组除给予常规治疗和护理外，结合音乐治疗。用汉密尔顿抑郁量表、汉密尔顿焦虑量表对其情绪进行评价。 结果 两组在疗程结束后，汉密尔顿焦虑量表和抑郁量表评分差异具有统计学意义（P＜0.01）。 结论 音乐治疗在改善儿童青少年情绪障碍方面具有显著作用。
Objective To explore the value of iodine overlay image technique based on dual-source CT dual-energy for the diagnosis in the primary hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization (TACE). Methods The imaging data of patients with primary hepatocellular carcinoma after TACE treatment from September 2015 to November 2018 were retrospectively analyzed. All patients completed dual-source CT dual-energy examination and digital subtraction angiography (DSA). The imaging data of the patients were analyzed by conventional linear blending images and iodine overlay image. The results of DSA were taken as the gold standard. The data indexes measured by the two imaging methods were compared. The consistency between the two imaging methods and DSA was determined by Kappa statistics. Results A total of 31 patients were included, and 57 nodes were found under DSA examination. The image quality evaluation (P<0.05), sensitivity (95.35% vs. 69.77%), specificity (92.86% vs. 64.29%), accuracy (94.74% vs. 68.42%), positive predictive value (97.62% vs. 85.71%) and negative predictive value (86.67% vs. 40.91%) of iodine overlay images were higher than those of conventional linear blending images. The consistency between conventional linear blending images and DSA was low (Kappa=0.286, P=0.023), and the consistency between iodine overlay images and DSA was excellent (Kappa=0.861, P<0.001). Conclusions Iodine overlay image could avoid the iodide artifact effectively and evaluate the abnormal enhancement quantitatively and qualitatively in patients undegoing TACE. This method could obtain more information to help diagnose in clinical and evaluate the postoperative efficacy of TACE accurately and objectively.
ObjectiveTo evaluate the mid- and long-term effectiveness of total hip arthroplasty (THA) with Ribbed femoral stem prosthesis.MethodsA clinical data of 354 patients (384 hips) with hip disease who underwent THA with Ribbed femoral stem prostheses between October 2006 and May 2016 was retrospectively analyzed. There were 171 males and 183 females, with an average age of 53.4 years (range, 20-82 years). There were 324 cases of single hip and 30 cases of bilateral hips. The cause of THA included the avascular necrosis of the femoral head in 151 cases (159 hips), hip osteoarthritis in 134 cases (136 hips), rheumatoid arthritis in 43 cases (43 hips), ankylosing spondylitis in 20 cases (40 hips), and trauma in 6 cases (6 hips). The Harris score of total 354 patients before operation was 42.34±8.89. Harris scores were used to evaluate hip function after operation. X-ray films were used to determine the length of the lower limb, the radiolucent line on the femur side, the stability of the prosthesis, and the occurrence of stress shielding.ResultsThe incisions healed by first intention. All patients were followed up 2-11 years with an average of 7.4 years. The Harris score at last follow-up was 80.52±7.61, which significantly increased when compared with preoperative score (t=134.804, P=0.000). Two cases (2 hips) of prosthetic infections, 3 cases (3 hips) of prothesis loosening, and 4 cases (4 hips) of periprosthetic fractures, and 48 cases (48 hips) of mild to moderate thigh pain occurred after operation. X-ray films showed 76 cases (78 hips) with radiolucent lines on the femur side and stress shielding. According to the Engh’s method, there were 364 hips of bone ingrowth, 15 hips of fibrosis ingrowth, and 5 hips of prosthesis instability. The femoral stem subsidence occurred in 25 cases (25 hips), and the difference in leg length discrepancy was more than 10 mm in 5 patients.ConclusionTHA with Ribbed femoral stem prosthesis can achieve satisfactory effectiveness with good initial stability and rapid bone growth. The incidence of stress shielding is relatively high, but the stress shielding has no significant impact on the mid- and long-term survival rate and effectiveness of femoral prosthesis.
ObjectiveTo investigate the short-term effectiveness of unicompartmental knee arthroplasty (UKA) in the treatment of knee osteoarthritis of super-age patients over 85 years old.MethodsSenile patients with unilateral compartment osteoarthritis of the knee who received UKA between November 2013 and May 2017 and met the inclusion criteria were enrolled as the research objects. Among them, 40 patients (50 knees) were more than 85 years old (super-age group) and 44 patients (50 knees) were 52-81 years old (control group). There was significant difference in age between the two groups (t=17.33, P=0.00). There was no significant difference in body mass index, degenerative classification of medial and lateral compartments, varus deformity of knee, disease duration, complicating diseases, and preoperative hemoglobin, hematocrit (HCT), American Hospital for Special Surgery (HSS) score, range of motion (ROM) of knee, visual analogue scale (VAS) score, and femoral-tibial angle (FTA) between the two groups (P>0.05). Hospital stay, hemoglobin, and HCT of the two groups were recorded before operation and on the first day after operation. The changes of hemoglobin and HCT after operation were calculated. During follow-up period, the ROM of the knee, HSS score, and VAS score were measured; the position of the prosthesis and FTA were observed by X-ray films.ResultsThere was no significant difference in hospital stay between the two groups (t=1.05, P=0.29). Hemoglobin and HCT of the two groups on the first day after operation were significantly lower than those before operation (P<0.05). There was no significant difference in the postoperative changes of hemoglobin and HCT between the two groups (P>0.05). All the patients were followed up completely except 4 cases (5 knees) in the super-age group. The follow-up time ranged from 14 to 44 months of super-age group (mean, 29 months) and 21 to 33 months of control group (mean, 24 months). There were significant differences in HSS score, VAS score, ROM of the knee, and FTA between pre-operation and last follow-up in the two groups (P<0.05). There was significant difference in HSS score between the two groups (P<0.05), and no significant difference was found in ROM, VAS score, and FTA between the two groups (P>0.05). X-ray film showed no adverse position of the prosthesis, infection around the prosthesis, prosthesis loosening, or pathological bright lines.ConclusionUKA combined with reasonable perioperative management in the treatment of super-age patients over 85 years with knee osteoarthritis is safe and feasible, and can obtain satisfactory short-term effectiveness.
Objective To analyze the effect of monitoring and modulating the portal vein pressure and blood flow during living donor liver transplantation （LDLT） on preventing small-for-size-syndrome (SFSS). Methods Data of forty-four LDLT recipients between Oct.2007 and Oct.2008 were reviewed. Actual graft-to-recipient weight ratio（GRWR）, portal vein flow and pressure during operation and syndrome of SFSS after operation were recorded. The patients received splenectomy or splenic artery ligation according to actual GRWR, portal vein flow and pressure and WBC. Relationships between patients’ GRWR, portal vein flow, portal vein pressure and occurrence of SFSS were analyzed. Results Six patients received splenectomy and 7 patients received splenic artery ligation to decrease the portal vein flow and pressure during the operation. The portal vein flow and pressure decreased after splenectomy （Plt;0.05）. The portal vein pressure decreased （Plt;0.05） and the portal vein flow had no significant change after splenic artery ligation （P＞0.05）. No SFSS occurred after operation. Conclusion Modulation of portal vein flow and pressure by splenectomy or splenic artery ligation during LDLT operation can decrease the portal vein flow and pressure, and which can prevent the incidence of SFSS.
Objective To investigate the anatomy of anterior and posterior terminal perforators of the peroneal artery and its clinical applications. Methods Six lower limb specimens were obtained from 3 fresh cadavers. The anterior and posterior terminal perforators and the perforator of terminal peroneal artery were exposed under surgical microscope, and the distances from the beginning of each perforator branch to the lateral malleolus tip and the external diameter of each perforator were measured. With these anatomical knowledge and contrast-enhanced ultrasound (CEUS) guidance, the pedicle flaps with above-mentioned perforators were rationally selected and precisely designed for 18 patients with skin defects in the ankle and foot region between October 2016 and December 2018. Among the patients, there were 14 males and 4 females, aged 28-62 years, with an average age of 40 years. The area of wound ranged from 4 cm×3 cm to 13 cm×10 cm and the area of skin flap ranged from 5 cm×4 cm to 14 cm×10 cm. The anterior peroneal artery terminal perforator flap were applied in 13 cases and the posterior peroneal artery terminal perforator flap in 5 cases. The donor sites were closed directly in 7 cases and repaired with full thickness skin graft in 11 cases. Results The distance from the beginning of the anterior terminal perforator to the lateral malleolus tip was (5.1±0.5) cm, the external diameter of the anterior terminal perforator was (1.51±0.05) mm. The distance from the beginning of the posterior terminal perforator to the lateral malleolus tip was (4.9±0.9) cm, the external diameter was (1.78±0.17) mm; the distance from the beginning of the perforator of terminal peroneal artery to the lateral malleolus tip was (1.7±0.7) cm, the external diameter was (0.58±0.12) mm. Clinical application results: The edge of the flap was dark in 2 cases after operation and healed after surgical dressing, and 1 case of wound infection healed gradually after debridement. The other flaps survived and healed by first intention. Three patients underwent plastic surgery at 3 months after operation due to flap swelling. All patients were followed up 3-18 months. During the follow-up period, the flaps had good texture and appearance, and partial recovery of sensation. All cases were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) score at last follow-up. The results were excellent in 9 cases, good in 6 cases, fair in 2 cases, and poor in 1 case, with the excellent and good rate of 83.3%. ConclusionFurther classification of peroneal artery perforators in the lateral malleolus region can improve clinical understanding and be helpful to selection and application of perforator flaps in the lateral malleolus.
Objective To systematically review the efficacy and safety of immune checkpoint inhibitors combined with chemotherapy in the treatment of triple-negative breast cancer. Methods The PubMed, Cochrane Library, Embase, Web of Science, CNKI, WanFang Data and VIP databases were searched for randomised controlled trials (RCTs) of immune checkpoint inhibitors combined with chemotherapy versus chemotherapy alone for triple-negative breast cancer from inception to April 1, 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. Results A total of 13 RCTs involving 5 416 patients were included. The results of meta-analysis showed that the pathologic complete response rate (pCR) (OR=2.09, 95%CI 1.37 to 3.19, P<0.01), progression-free survival (PFS) (HR=0.75, 95%CI 0.67 to 0.83, P<0.01) and overall survival (OS) (HR=0.87, 95%CI 0.79 to 0.96, P<0.01) were significantly better than those in the control group. The results of subgroup analysis showed that there were statistically significant differences in PFS (P<0.01) and OS (P=0.02) between PD-L1-positive and PD-L1-negative patients, but there was no statistically significant difference in pCR between PD-L1-positive patients and PD-L1-negative patients (P=0.36). There was a statistically significant difference in pCR between node-positive patients and node-negative patients (P=0.03). There was no statistically significant difference in pCR between patients treated with PD-1 inhibitors and PD-L1 inhibitors (P=0.32); and there was no significant difference in PFS (P=0.19) or OS (P=0.99) between patients treated with PD-1 inhibitors and PD-L1 inhibitors. Compared with those in the control group, the incidences of serious adverse events (RR=1.36, 95%CI 1.09 to 1.70, P<0.01) and immune-related adverse events (RR=2.98, 95%CI 1.66 to 5.35, P<0.01) were higher in the experimental group, and the common immune-related adverse events were hypothyroidism and hyperthyroidism.Conclusion The existing evidence shows that immune checkpoint inhibitors combined with chemotherapy are more effective than chemotherapy alone in the treatment of triple-negative breast cancer, and the combination therapy has a higher incidence of adverse reactions. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To discuss the criteria of recipient selection，surgical approach，and complications and its theray by using of pediatric donation after cardiac death liver graft in adult recipient. Methods The clinical data of one case of pediatric donation after cardiac death liver to adult recipient was analyzed retrospectively and the literatures were reviewed. Results A 6-year-old girl pronounced brain death due to drowning and on the basis of cardiopulmonary criteria donated the organ．The liver graft weight was 598 g and the warm ischemic time was 10 min. The liver donor was transplanted to a 64-year-old woman，the graft to recipient weight ratio was 1.09%，the graft volume/estimated standard liver volume was 61.8%．The classic orthotopic liver transplantation without bypass was underwent，the postoperative recovery was smooth after the liver transplantation．The CT scan showed that the liver graft volume was 1 003cm3 on day 14 after operation．The patient was discharged on 45 d after orthotopic liver transplantation and the liver function was normal when followed-up 3 months after the operation. Conclusions Pediatric donation after cardiac death liver graft can be successfully utilized to adult recipient．Recipient selection and surgical approach should be decided by conditions of both donor and graft．