ObjectiveTo systematically evaluate the effect of Dexmedetomidine (Dex) on postoperative cognitive dysfunction (POCD) of Chinese patients undergoing abdominal surgeries. MethodsWe searched databases including PubMed, Web of Science, CNKI, CBM, VIP and WanFang Data from inception to April 2015, to collect randomized controlled trials (RCTs) about evaluating the effect of Dex on POCD of Chinese patients undergoing abdominal surgeries. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. ResultsA total of 8 RCTs were included. The results of meta-analysis showed that:compared with the control group, the MMSE scores of the Dex group were higher after surgeries in the first day (MD=1.46, 95%CI 0.98 to 1.95, P<0.000 01), the second day (MD=2.46, 95%CI 2.11 to 2.81, P<0.000 01), the third day (MD=1.81, 95%CI 0.37 to 3.25, P=0.01) and the seventh day (WMD=2.03, 95%CI 1.64 to 2.43, P<0.000 01). ConclusionCurrent evidence shows that the usage of Dex during abdominal surgeries can reduce the incidence of POCD in Chinese patients. Due to the limited quantity and quality of included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the efficacy of lamivudine (LAM) plus adefovir (ADV) versus entecavir (ETV) monotherapy for LAM-resistant chronic hepatitis B patients. MethodsWe electronically searched databases including PubMed, The Cochrane Library (Issue 12, 2013), CBM, CNKI, VIP, WanFang Data from their inception to December 2013, to collect randomized controlled trials (RCTs) or cohort studies of LAM+ADV versus ETV for LAM-resistant chronic hepatitis B. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 13 RCTs and 5 cohort studies involving 1 336 patients were included. The results of meta-analyses of RCTs showed that:there were no significant differences between the LAM+ADV group and the ETV group in the negative rates of serum HBV-DNA (RR=1.00, 95%CI 0.91 to 1.10, P=0.94), HBeAg (RR=0.90, 95%CI 0.70 to 1.17, P=0.43), serum ALT recovery rate (RR=0.97, 95%CI 0.90 to 1.05, P=0.45) and serum HBeAg conversion rate (RR=0.71, 95%CI 0.40 to 1.24, P=0.22) at the 48th week. The results of meta-analyses of cohort studies showed that:there were no significant differences between the two groups in the negative rates of serum HBV-DNA (RR=1.37, 95% CI 0.91 to 2.06, P=0.13) and serum ALT recovery rate (RR=0.99, 95%CI 0.87 to 1.12, P=0.87), but the ETV group had higher serum HBeAg conversion rate (RR=0.24, 95% CI 0.07 to 0.79, P=0.02). ConclusionCurrent evidence shows that the efficacy of LAM+ADV is similar to ETV at the 48th week for LAM-resistant chronic hepatitis B patients. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
In order to guarantee the safety and accuracy of the whole treating process as well as better link up of each section during the treatment, we did research in order to establish a project concerning the process quality control (PQC) of treating liver cancer with CyberKnife. From the safety and accuracy point of view, we divided the whole process of treating liver cancer with CyberKnife into ten links, i.e. the registration of patients' information, the implantation of fiducial markers, fixation of body posture, CT localization, target delineation, design of the treatment plan, quality assurance in physics, implementation of the treatment plan, inspection on the correctness and data archiving. We analyzed the possible mistakes in each link and the consequences brought by them. To smoothly connect all the links, a special part "Attention" was added between every two links. Various wrong operations which may influence the safety and accuracy of treatment were illustrated, and the consequences brought by them were also explained. The "Attention" part among links offers important information for the next step, and gives us reminding and warnings. The project of quality control covers all the important links when treating liver cancer with CyberKnife. It offers regulations, reminding and warning for us so that the safety and accuracy of treatment can be guaranteed, and the work of all staff could be closely connected.
The aim of this research is to investigate the preparation method of valve membrane in transcatheter bioprosthetic valve, and to study the effect of chemical modification and cutting technology to tensile property and suture force property of valve membrane. We carried out a series of processes to perform the tests, such as firstly to test the crosslinking degree of valve membrane using ninhydrin method, then to test the tensile property and suture force property by using Instron's biomechanical testing equipment, and then to observe the collagen fiber orientation in valve membrane using Instron's biomechanical testing equipment and using field emission scanning electron microscopy. The study indicated that after the chemical modification, the crosslinking degree, tensile strength and suture force strength increasing rate of valve membrane were 93.78%±3.2%, (8.24±0.79) MPa, 102%, respectively. The valve membrane had a better biomechanical property and would be expected to become valve membrane in transcatheter bioprosthesis valve.
ObjectiveTo investigate the effect of tension suture on healing quality of incision after abdominal surgery, and to provide a theoretical basis for reducing post-operative wound complications. MethodLiteratures on the tension suture in the application of abdominal incision were searched from January 2005 to January 2015, and then a Meta-analysis was carried out based on the data obtained from CBM, CNKI, and WanFang database. ResultsEight articles involving 2 001 patients with abdominal surgery, including 1 044 cases in tension suture group, and 957 cases in the conventional suture group, were incorporated. The Meta analysis results showed that, the technique of tension suture could reduce the incidence of post-operative wound infection (OR=0.40, 95% CI: 0.28-0.57, P<0.05), fat liquefaction (OR=0.51, 95% CI: 0.37-0.69, P<0.05), incisional hernia (OR=0.11, 95% CI: 0.04-0.34, P<0.05), wound dehiscence (OR=0.13, 95% CI: 0.07-0.25, P<0.05), and second stage surgery (OR=0.16, 95% CI: 0.09-0.30, P<0.05). But, it would also augment the risk of post-operative skin incision necrosis (OR=15.14, 95% CI: 2.79-82.08, P<0.05). On the other hand, the method of tension suture had no effect on the subcutaneous hemorrhage in the incision area (OR=0.58, 95% CI: 0.30-1.13, P>0.05). ConclusionsCompared with conventional suture, tension suture can reduce the hazard of wound infection, fat liquefaction, incisional hernia, wound dehiscence, and reoperation after abdominal surgery. In contrast, it can also increase the risk of post-operative skin incision necrosis.
ObjectiveTo evaluate short and medium term results of nitinol self-expending stent (LifeStent) implantation for iliac arteriosclerosis obliteran. MethodsThe clinical data of 75 limbs iliac artery occlusions in 64 patients from June 2011 to June 2014 in this hospital were analyzed retrospectively. The postoperative ankle brachial index (ABI), limb salvage rate, primary and secondary patency rate, and postoperative complications were evaluated. ResultsThere were 75 limbs iliac artery occlusions in 64 patients (54 males and 10 females), 11 lesions were type A of TASCⅡ, 26 lesions were type B of TASCⅡ, 29 lesions were type C of TASCⅡ, 9 lesions were type D of TASCⅡ. The postoperative ABI was significantly higher than that preoperative ABI (0.94±0.16 versus 0.29±0.20, t=-24.7, P < 0.01). The following-up time was (22±10) months, 5 patients were lost to follow-up. In 12 and 24 months after surgery, the cumulative primary patency rates were 79% and 60%, respectively, the cumulative second patency rates were 91% and 84%, respectively, the limb salvage rates were 96% and 94%, respectively. Complications occurred in 5 patients (7.8%). There was no severe complications and inhospital mortality. ConclusionClinical efficacy of short and medium term is satisfactory by nitinol self-expending stents implantation (LifeStent) for iliac arteriosclerosis obliteran, but long term efficacy remains to be further studied.
ObjectiveTo research the effect of different surgical sutures on abdominal surgical incision healing quality, and provide a novel theory basis for promoting the healing of incision of abdominal wall. MethodsTotally 341 patients who underwent laparotomy were collected from general surgery of Affiliated Hospital of North Sichuan Medical College, and they were randomly divided into three groups: the including polydioxanoneⅡ(PDSⅡ) suture group, abdominal wall incision except the skin was successively sutured with PDSⅡsuture; the Vicryl group, abdominal wall incision except the skin was successively suture with antibacterial Vicryl; and the common silk thread group, abdominal wall incision was performed layering intermittent silk suture. ResultsIn terms of suture time, the PDSⅡsuture group [(11.23±1.62) min〕was significantly lower than the Vicryl group [(14.04±1.20) min〕, P < 0.05, and also both were significantly lower than the ordinary silk thread group [(21.95±1.95) min〕, P < 0.05. In respect of rejection reaction, incision infection and incision split, the PDSⅡsuture group and the Vicryl group were significantly lower than the ordinary silk thread group (P < 0.05), but compared the PDSⅡsuture group with the Vicryl group, the differences were not statistically significant (P > 0.05). Regarding post operation hospitalization duration, fat liquefaction and effusion, compared the differences between the three groups were not statistically significant (P > 0.05). ConclusionFull fascia is successively suture with PDSⅡsutures and antibacterial Vicryl suture that can significantly shorten the suture time, reduce the incidence of rejection incision, wound infection and wound dehiscence and promote the postoperative recovery of the patients.