ObjectiveTo explore an individualized treatment program to prevent the initial bleeding of a patient with cirrhosis and esophageal varices by the methods of evidence-based medicine.
MethodsOne patient with cirrhosis and esophageal varices was admitted into our hospital on November 2, 2013. After evaluating the patient's condition adequately, we proposed the problem according to the PICOS principles. Then, we assessed the clinical evidence from the Cochrane Library (1990-2012), Medline (1950-2012), Embase (1991-2012), VIP (1989-2013), and CBM (1990-2013). The individualized treatment plan was made through doctors' experiences and analysis of those high-quality evidences from the databases.
ResultsEight studies (randomized controlled trials and 5 meta-analysis) were included. We evaluated a series of associated problems:whether we should take measurement to prevent initial bleeding of esophageal varices; which one (β-blockers or ligation of esophageal varices) was the best method to prevent the initial bleeding based on efficacy, complication and cost-effectiveness. Then, according to the evidences and the patient's view, we gave non-selectiveβ-blocker as the primary prevention. After one-year followed-up, the initial bleeding of the patient did not occur.
ConclusionMaking the prevention plan for a patient with cirrhosis and esophageal varices can not only find out the individualized program, but also push the patient to make decision for their own health.
ObjectiveTo investigate the influence of different temperatures of distilled water on the general sensation of patients during endoscopic ultrasonography (EUS) examination.
MethodsSixty patients who received EUS examination were randomly assigned to trial group and control group. The trial group used (40±1) ℃ distilled water, while the control group accepted 26-28℃ distilled water. The operating time and the grade of discomfort symptoms such as general discomfort, abdominal pain, nausea, vomiting and terror were observed.
ResultsSignificant differences in general discomfort, nausea, vomiting and terror were found between the two groups (P ＜ 0.001) . Abdominal pain was not found in either group. The examination time in each group did not show any significant difference (P ＞ 0.05) .
ConclusionDifferent distilled water temperatures significantly influence the sensation of patients during the EUS examination, and distilled water with a temperature of (40±1) ℃ is able to relieve the discomfort of patients.
ObjectiveTo explore the risk factors for postoperative pneumonia (POP) following esophagectomy for esophageal cancer, and to identify potential clinical indicators for predicting POP. MethodsA retrospective analysis was conducted on the clinical data of patients with esophageal cancer who underwent esophagectomy at the Department of Thoracic Surgery, West China Hospital of Sichuan University from 2017 to 2021. Perioperative clinical indicators were collected to analyze the risk factors for the occurrence of POP. Patients were divided into a POP group and a non-POP group according to whether POP occurred. Results A total of 613 patients with esophageal cancer were included, comprising 472 males and 141 females, with a median age of 62.0 (53.0, 67.0) years. Among them, 51 patients were in the POP group, and 562 patients were in the non-POP group. Multivariate logistic regression analysis showed that the forced expiratory volume in 1 second percentage of predicted (FEV1%) [OR=0.958, 95%CI (0.943, 0.973), P<0.001], systemic immune-inflammation index (SII) [OR=1.001, 95%CI (1.000, 1.002), P=0.007], and prognostic nutritional index (PNI) [OR=0.869, 95% CI (0.813, 0.928), P<0.001] were independent risk factors for POP. Receiver operating characteristic (ROC) curve analysis combining FEV1%, SII, and PNI demonstrated that the area under the curve (AUC) for predicting POP was 0.826 [95%CI (0.793, 0.855), cut-off value: 0.08, sensitivity: 80.3%, specificity: 72.4%, Youden index: 0.528, P<0.001]. Cross-validation confirmed that the combined indicators had the highest predictive efficacy, which was significantly superior to that of any single indicator alone. Conclusion Preoperative levels of FEV1%, SII, and PNI are closely associated with the occurrence of POP following surgery for esophageal cancer. The combined application of FEV1%, SII, and PNI demonstrates good predictive efficacy for the occurrence of POP.
