Objective
To explore the preventive effectiveness of early physiotherapy on arm lymphedema after modified radical mastectomy for breast cancer.
Methods
A total of 206 patients who underwent modified radical mastectomy for breast cancer in The First Affiliated Hospital of Henan University from June 2014 to June 2016, enrolled in this randomized controlled clinical trial. Then these patients were randomly divided into intervention group and control group equally. Patients in the control group received routine treatment, and the patients in the intervention group began to use the air pressure pump combined with the microwave physiotherapy on the second day after the radical surgery. The incidences of limb lymphedema in 6 months and 1 year after operation between the 2 groups were compared, and the influencing factors of arm lymphedema were explored.
Results
The clinical data of 195 patients were analyzed at end, including 99 patients of the intervention group and 96 patients of the control group. ① There were statistical significance in the incidences of arm lymphedema in 6 months and 1 year after operation between the 2 groups (P<0.05), that incidences of arm lymphedema in the intervention group were both lower than those of the control group at the2 time points [6 months after operation: 2.0% (2/99)vs. 9.4% (9/96); 1 year after operation: 5.1% (5/99) vs. 17.7% (17/96)]. ② The results of non-conditional logistic regression analysis shown that, age (OR=1.45, P=0.008), tumor location (OR=1.72, P<0.001), TNM stage (OR=2.01, P=0.033), the number of invasive axillary lymph nodes (OR=1.15, P=0.005), and postoperative radiotherapy (OR=1.23, P=0.016) were the influencing factors of arm lymphedema after modified radical mastectomy for breast cancer, patients with age older than 60 years, tumor position at the outside area, stage Ⅲ of TNM, the number of invasive axillary lymph nodes >5, and patients received radiotherapy after operation had high risk of arm lymphedema.
Conclusion
Early physiotherapy can effectively prevent the occurrence of arm lymphedema after modified radical mastectomy for breast cancer, and early physiotherapy should be performed for patients with high risk of arm lymphedema.
Objective
To explore the effect of pulmonary arterial hypertension on the children with functional single ventricle in the early period after Fontan operation.
Methods
Forty-three children with pulmonary arterial hypertension after Fontan operation were enrolled in our department between January 2015 and December 2016. There were 24 males and 19 females at a median age of 4.3 years ranging from 2.5 to 4.8 years. The pulmonary arterial pressure was evaluated by cardiac catheterization. There were 23 children diagnosed without pulmonary hypertension (a non-PAH group) including 16 males and 7 females, while 20 patients were diagnosed with pulmonary hypertension (a PAH group) including 8 males and 12 females. Postoperative parameters related to outcomes were compared between the two groups.
Results
There was no death in the non-PAH group, but the mortality of children in the PAH group was 20.0% (4/20, χ2=5.34, P=0.02). The central venous pressure (t=–2.50, P=0.02), N-terminal prohormone of brain natriuretic peptide (NT-proBNP, Z=–3.50, P<0.01), peritoneal dialysis rate (χ2=5.40, P=0.02), incidence of arrhythmia (χ2=4.40, P=0.03) in the PAH group were significantly higher than those of the non-PAH group. The early postoperative utilization rate of pulmonary vascular targeting agents in the PAH group was significantly higher than that in the non-PAH group (χ2=6.30, P=0.04).
Conclusion
Pulmonary arterial hypertension is one of the most important factors which influence the early postoperative prognosis of children with functional single ventricle after Fontan operation.
Sepsis is a systemic inflammatory response syndrome caused by infection, with high fatality rate and complex pathogenesis. Early and accurate diagnosis is essential to improving the prognosis of patients with sepsis. This review briefly describes the basic pathogenesis of sepsis, and summarizes the current new technologies for detecting sepsis from two aspects: pathogen detection and host immune status detection, such as digital polymerase chain reaction, biosensors, fluorescent probes, single-cell RNA sequencing, and enzyme-linked immunospot assay. By comprehensively analyzing and applying these new techniques, it is helpful to improve the efficiency and accuracy of early diagnosis of sepsis and improve the clinical treatment effect of patients.
ObjectiveTo explore the applicability of early goal-directed sedation (EGDS) in intensive care unit (ICU) patients with mechanical ventilation.MethodsAn prospective double blind study was conducted. ICU patients with mechanical ventilation in the First Affiliated Hospital of Jinzhou Medical University were recruited as research objects by chester sampling from September 2015 to September 2017, and divided into an experimental group and a control group by stratified randomization. Two groups were sedated on the basis of adequate analgesia. The experimental group adopted the EGDS strategy that dexmedetomidin was the first choice to be infused at the rate of 1 μg·kg–1·h–1. And the patients were given Richmond agitation-sedation score (RASS) on the interval of 4 hours: used additionally propofol and midazolam if RASS>2, or reduced right metomomidin at the speed of 0.2 μg·kg–1·h–1 per 30 min if RASS<–3, and stopped sedation until RASS of –2 to 0. The control group adopted routine sedation strategy that propofol was the first choice to be infused and combined with dexmedetomidine and midazolam until RASS score in –2 to –3. The doses of sedative drugs, mechanical ventilation time, ICU-stayed time, total hospitalization time and the incidence of adverse events such as delirium, accidental extubation, and ICU death were compared between two groups.ResultsSixty-sis cases were selected in the experimental group and 71 in the control group. The baseline data such as gender, age, acute physiology chronic health evaluation Ⅱ (APACHEⅡ), or basic diseases in two groups had no significant differences. Compared with the control group, the per capita total doses of dexmedetomidine, propofol and midazolam in the experimental group were significantly less [right metopromicine (μg): 154.45±27.86 vs. 378.85±39.76; propofol (mg): 4 490.03±479.88 vs. 7 349.76±814.31; midazolam (mg): 255.38±46.24 vs. 562.79±97.26; all P<0.01], mechanical ventilation time, ICU-stayed time, total hospitalization time were significantly lower [mechanical ventilation time (d): 7.7±3.3vs. 11.7±3.6; ICU-stayed time (d): 10.2±3.9 vs. 19.2±4.1, total hospitalization time (d): 29.9±4.6 vs. 50.4±9.1; all P<0.01]. The Kaplan-Meier survival curves showed that the incidence of delirium in the experimental group was significantly lower than that in the control group (log-rankχ2=5.481, P<0.05). The accidental extubation rate and accidental fatality rate in two groups had no significant differences (log-rankχ2=0.078, 0.999, P>0.05).ConclusionEGDS can not only reduce the dose of sedative drugs, shorten the mechanical ventilation time, the ICU-stayed time and the total hospitalization time, but also reduce the incidence of delirium, so it has a positive impact in ICU patients with mechanical ventilation.
Objective To investigate the development and significance of the expression of early growth response gene-1 （EGR-1） in autogenous vein graft in rats and detect the role of it in intimal hyperplasia. Methods Autogenous vein graft model was established in 90 Wistar rats, transplanting the right jugular vein to infra renal abdominal aorta by microsurgical technique. The vein graft samples were harvested at hour 1, 2, 6 and 24, day 3, 7,14, 28 and 42 after procedure. Normal vein as control group. Egr-1 mRNA was measured by reverse transcription-PCR and in situ hybridization. Western blot and immunohistochemistry were used to detect the protein expression of Egr-1. Results Intimal hyperplasia reached peak at day 28 after autogenous vein graft surgery. Egr-1 mRNA and Egr-1 protein hadn’t been found in the normal vein. The expressions of Egr-1 mRNA and Egr-1 protein had biphasic changes. By reverse transcription-PCR and in situ hybridization, we found that the level of Egr-1 mRNA rose at 1 hour after graft, the expression of Egr-1 mRNA was (35±7)%. Decline at hour 6， 24 and day 3, the positive rates of Egr-1 mRNA were (8±2)%, (8±6)% and (8±4)% respectively. Reincrease at day 7, a peak at day 28, the positive rate of Egr-1 mRNA was (45±6)% (compared with other phase, P＜0.01). At day 42, the expression of Egr-1 mRNA declined again. Immunohistochemical staining and Western blot revealed Egr-1 protein had expressed at hour 2 early phase, the expression of Egr-1 protein was (30±5)%, and until to hour 6. The level of Egr-1 protein was decrease at hour 24 and day 3, the positive rates were (7±3)% and (7±8)% respectively. A peak at day 28, the positive rate of Egr-1 protein was (40±9)% (compared with other phase, P＜0.01). We found that immu-noreative Egr-1 located vascular smooth muscle cells （VSMCs） and monocytes/macrophages in tunica media at the early phase of day 7 and 14, and in neointimal and medial VSMCs at later phase of day 28. Egr-1 was also present in the endoluminal endothelial cells. Conclusion In autogenous vein graft, Egr-1 plays an important role in the proliferation of VSMCs. Egr-1 may become a new target for the prevention and therapy of intimal hyperplasia, stenosis and emphraxis after vein graft.
ObjectiveTo explore the advantages and operation skills of ultra-early small bone window craniotomy surgery on cerebral hemorrhage in basal ganglia regions.
MethodsWe retrospectively analyzed the clinical data of 58 patients with cerebral hemorrhage in basal ganglia regions who underwent ultra-early small bone window craniotomy between January 2009 and December 2012.
ResultsPatients within 24 hours after surgery were re-checked by CT scan, which showed that hematoma was cleared in 53 cases, most removed in 2 cases, re-hemorrhage occurred in 2 patients whose hematoma was immediately removed by the original incision, 1 patient had large area infarction and underwent bone flap decompression. According to Glasgow outcome scale score at discharge, the outcome was good in 23, moderate disability in 18, severe disability in 12, persistent vegetative state in 2 and 3 were dead.
ConclusionUltra-early skull-window craniotomy can timely and completely remove the hematoma, provide reliable coagulation, protect important arteries with less re-hemorrhage and excellent outcome, which is one of the most effective methods for treating cerebral hemorrhage in basal ganglia regions.
ObjectiveTo explore the effect of rehabilitation training focusing on early exercise on the time of first getting out of bed after surgery, pain during early activities, postoperative infection rate and the length of hospital stay for renal transplant recipients.MethodsThe clinical data of patients undergoing allogeneic renal transplantation in West China Hospital of Sichuan University from June to August 2020 were analyzed retrospectively. According to the time of multidisciplinary postoperative management and the time of early rehabilitation intervention, the patients were divided into the conventional group (from June 2020 to the beginning of multidisciplinary postoperative management) and the rehabilitation group (after multidisciplinary postoperative management). The time to get out of bed for the first time after surgery, the Visual Analogue Score (VAS) during weight monitoring on the second day post operation, the number of days required to complete an independent walk of 100 meters, postoperative complications, the incidence of postoperative infection and the length of hospital stay were compared between the two groups.ResultsA total of 79 patients were included. There were 46 cases in the conventional group and 33 cases in the rehabilitation group. Among the included patients, 14 patients had postoperative infection, 1 patients in the conventional group developed thrombosis, no catheter shedding or bleeding after exercise occurred. The differences between the rehabilitation group and the conventional group in the time to get out of bed for the first time after surgery [(1.1±0.2) vs. (2.2±0.4) d; t=13.224, P<0.001], the VAS during weight monitoring on the day post operation (2.5±0.9 vs. 3.4±1.4; t=3.267, P<0.001), the number of days required to complete an independent walk of 100 meters [(2.2±0.4) vs. (4.0±0.8) d; t=11.312, P<0.001], and the incidence of postoperative infection (6.1% vs. 26.1%; χ2=5.285, P=0.022) were statistically significant. There was no significant difference in the length of stay between the rehabilitation group and the conventional group [(19.8±5.8) vs. (20.7±7.4) d; t=0.584, P=0.561].ConclusionEarly postoperative rehabilitation training reduces the time required for renal transplant recipients to get out of bed for the first time post operation and to walk 100 meters independently, reduce the pain response during early activities, and reduce the incidence of postoperative infection.
