ObjectiveTo evaluate the effect of glutamineenhanced enteral nutritional support on elder patients after total gastrectomy. MethodsA total of eightyfour cases of elder patients receiving total gastrectomy were included in this study from February 2008 to August 2010. The patients were randomly divided into three groups: glutamineenhanced enteral nutrition (Gln) group, enteral nutrition (EN) group and parenteral nutrition (PN) group. The complications and hospital stay after operation were compared, and the levels of serum total protein, albumin, proalbumin， and transferrin of patients were measured before operation, on 2 d and 10 d after operation, respectively. Furthermore, the percentage of CD4 and CD8 T cells, CD4/CD8 ratio， and the levels of serum IgM and IgG of patients in peripheral blood before and after operation were detected. ResultsNutritional therapy was successfully performed in patients of three groups. The anal exhaust time and hospital stay after operation of patients in Gln group and EN group were significantly lower than those in PN group (Plt;0.05). The difference of postoperative complications and digestive tract symptoms of patients in three groups was not obvious (Plt;0.05). Anastomotic fistula occurred in one patient of PN group on 6 d after operation and was cured by conservative treatment for 54 d. The difference of total protein, albumin, proalbumin, and transferrin levels of patients in three groups before operation was not significant (Pgt;0.05), and these indexes fell dramatically on 2 d after operation and lower than before operation (Plt;0.05), although the intergroup difference was not statistically significant (Pgt;0.05). On 10 d after operation, all indexes recovered in different extent, while those data in Gln group and EN group were significantly higher than those on 2 d after operation (Plt;0.05). The levels of total protein, albumin, and proalbumin of patients in Gln group and EN group were markedly higher than those in PN group (Plt;0.05), although there was no difference between the former groups (Pgt;0.05). The difference of several immunological parameters of patients in three groups before operation was not significant (Pgt;0.05). On 10 d after operation, the percentage of CD4 and CD8 T cells, CD4/CD8 ratio, and the levels of serum IgM and IgG of patients in Gln group returned and even exceeded the preoperative results, which were significantly higher than those in EN group and PN group other than IgM (Plt;0.05). The postoperative results of all parameters except IgG in EN group were significantly lower than preoperative results in patients of EN group and PN group (Plt;0.05). ConclusionsIt is safe and feasible to elder patients who had received total gastrectomy and perioperative glutamine-enhanced nutritional support, which can improve nutrition and immune status, promote the recovery and reduce the duration of hospital stay, and nutritiional support after total gastrectomy is one of the optimal choices for these patients.
ObjectivesTo explore the impact of the medical consortium of a tertiary grade A hospital on the economic benefits and business levels of the community hospitals, to summarize the problems of the current medical joint mode, and to provide suggestions for promoting the medical association model.MethodsWe collected the data of economic benefit and business level of a tertiary grade A hospital and its affiliated community hospitals before and after the implementation of the medical consortium model [2016 (pre-implementation) and 2017 (post-implementation)], and analyzed the differences between the two groups. Patients were selected by stratified sampling method before and after the implementation, investigations and follow-up were conducted. The satisfaction and compliance were analyzed.ResultsCompared with the data in 2016, in 2017, the total income of community hospitals increased by 25.13% (2.671 2 million yuan vs. 2.134 7 million yuan), the number of outpatients increased by 15.55% (7 496 vs. 6 487 cases), the number of hospitalizations increased by 59.49% (1 673 vs. 1 049 cases), and the number of students increased the most, reaching 366.67% (14 vs. 3). Finally, a total of 472 patients were included, including 213 in pre-implementation group and 259 in post-implementation group. There was no significant difference in the general data between the two groups (P>0.05). The patients’ satisfaction and compliance in post-implementation group were better than those in pre-implementation group (P<0.05). In June and December 2017, the hospital’s medical staff business test level increased significantly compared with those in the same period in 2016 (t=−7.467、−9.998, P<0.001), and the results in December 2017 were significantly higher than those in June 2017 (t=−4.719, P<0.001). But there was no significant difference in the performance of business level assessment between the results in June 2016 and in December 2016 (t=−1.158, P=0.250).ConclusionAn effective “Three Construction and One Management” model can promote the advancement of medical standards in community hospitals while promoting the effective improvement of economic benefits and improving the patients’ satisfaction.
Objective To analyze the biomechanical changes of the adjacent cervical facet joints when the angled cervical prosthesis is replaced. Methods A total of 400 northwestern people were involved, with an age of 40 years or older.The cervical vertebra lateral X-ray films were taken, and the cervical angles were measured by professional computer aided design software, then the cervical intervertebral disc prosthesis with 10° angle was designed. The finite element models of C4，5and C4-6 segments with intact cervical discs were developed; the C4，5 disc was replaced by the cervical prosthesis with 0° and 10° angle respectively; and then all models were subjected to axial loading, flexion/extension, lateral bending, and torsion loading conditions; the stress effects on adjacent facet joints after replacement were observed by comparing with that of the intact model. Results The cervical angles were (9.97 ± 3.64)° in C3，4, (9.95 ± 4.34)° in C4，5, (8.59 ± 3.75)° in C5，6, and (8.49 ± 3.39)° in C6，7, showing no significant difference between C3，4 and C4，5, C5，6 and C6，7 (P gt; 0.05) and showing significant differences between the other cervical angles (P lt; 0.05). When C4，5 model was axially loaded, no significant difference in equivalent shearing stress were observed in intact, 0°, and 10° groups; at flexion/extension loading, the stress was biggest in intact group, and was smallest in 10° group; at lateral bending, the stress got the high rank in intact group, and was minimum in 10° group; at torsion loading, the stress state of 10° group approached to the intact one condition. When C4-6 model was loaded, the facet joint stress of the replaced segment (C4，5) decreased significantly at axial loading, flexion/extension, and lateral bending; while no obvious decrease was observed at torsion loading; the stress of the adjacent inferior disc (C5，6) decreased significantly at axial loadingand lateral bending condition, while less decrease was observed at torsion loading, no significant change at flexion/extension condition, it approached to that of the intact one. Conclusion The finite element analysis reveals that the biomechanical properties of 10° designed prosthesis is approximate to that of the intact cervical disc, thus the 10° designed prosthesis can meet the requirements of biomechanical function reconstruction of the cervical spine.