ObjectiveTo systematically review the efficacy of closed and open tracheal suction system on the prevention of ventilator-associated pneumonia.MethodsThe Cochrane Library, CNKI, WanFang Data, Airiti Library, PubMed, CINAHL and Proquest databases were electronically searched to collect randomized controlled trials (RCTs) on closed and open tracheal suction system on the prevention of ventilator-associated pneumonia. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 11 RCTs involving 1 187 patients were included. The results of meta-analysis showed that compared with open tracheal suction system, closed tracheal suction system was associated with a reduced incidence of ventilator-associated pneumonia (RR=0.55, 95%CI 0.44 to 0.67, P<0.000 01), late-onset ventilator-associated pneumonia (RR=0.47, 95%CI 0.28 to 0.80, P=0.005), length of stay in intensive care unit (MD=−0.85, 95%CI −1.66 to −0.04, P=0.04) and rate of microbial colonization (RR=0.69, 95%CI 0.56 to 0.86, P=0.000 9). However, there were no significant differences between two groups in time to ventilator-associated pneumonia development (MD=0.96, 95%CI −0.21 to 2.12, P=0.11), length of mechanical ventilation (MD=−2.24, 95%CI −4.54 to 0.06, P=0.06), and rate of mortality (RR=0.88, 95%CI 0.73 to 1.05, P=0.15).ConclusionsCurrent evidence shows that compared with open tracheal suction system, closed tracheal suction system can reduce the incidence of ventilator-associated pneumonia and late-onset ventilator-associated pneumonia, shorten the hospital stay in intensive care unit, and reduce rate of microbial colonization. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Spanning two decades since the 1st generation spinal robotics inception, the robot-assisted spine surgery (RSS) technology has evolved through generations, culminating in the 4th generation characterized by real-time visual navigation and wire-free screw placement. The fundamental principles of RSS technology include surgical planning, tracking, image registration, and robotic arm control technologies. Currently, RSS technology is maturely employed in thoracolumbar procedures and is progressively being applied in cervical surgeries, spinal tumor resections, and percutaneous operations, offering advantages in reducing tissue trauma and exposure to radiation, thereby improving patient outcomes. Emerging research also focuses on the cost-effectiveness of clinical applications and robot-specific complications. With the integration of artificial intelligence into surgical planning, RSS technology is poised to further incorporate emerging technologies and expand its application across a broader clinical spectrum.
Objective To explore the effectiveness and safety of topical phenytoin for wound healing. Methods We searched MEDLINE (1966 to Oct. 2002), EMBASE (1984 to 2002), The Cochrane Library (Issue 4, 2002), Biological Abstracts (1993 to 1996), Cancerlit (1997 to Sept. 2002), Life Science Collection (1982 to Mar. 1995), International Pharmaceutical Abstracts (1970 to 2002), and CBMdisc (1978 to Jan. 2003). Controlled trials on topical phenytoin for wound healing were identified. The methodological quality of included studies was assessed, and a descriptive analysis was performed. Results Nine studies (507 cases) including 1 randomized controlled trials (RCT) and 8 non-randomized controlled trials were included. These studies were of poor methodological quality. Because there were a variety of etiology of ulcers, differnet interventions in control groups, and different outcome measures, for which meta-analysis was difficult to perform, a descriptive analysis of the results was presented. Most studies showed that topical phenytoin had better effects on improving healthy granulation appearance, increasing complete recovery rate, reducing time for complete recovery, and positive cases of bacterial culture than those of control groups. Mild side effects were observed in only one study.Conclusions The reviewers think that the inclusion studies less rigorous than randomized controlled trials could result in misleading findings.Some well designed randomized controlled trials of topical phenytoin for wound healing are warranted.
Objective To evaluate the effect of auto adjusted triggering mechanism on the triggering balance of sensitivity and anti-interference in non invasive ventilator field. Methods Taking the breathing simulator as the experimental platform, for the same ventilator, the experiments of "automatic adjustment mode" and "manual adjustment mode" were carried out in a self-control manner, comparing the sensitivity and anti-interference indexes of the experimental group and the control group in the triggering stage. The results were statistically analyzed. Results In case of large air leakage, for ventilator of "A40", the group of "automatic adjustment mode" presented auto-triggered cycle and the group of "manual adjustment mode" (the inspiratory trigger sensitivity was adjusted to 5 to 9 L/min) could provide breathing assistance ventilation. While for ventilator of "VENT", both the group of "automatic adjustment mode" and the group of "manual adjustment mode" (the inspiratory trigger sensitivity was adjusted to 1 to 8 arbitrary unit) appear auto-triggered cycle. In case of medium air leakage, for ventilator of "A40", the trigger delay time, trigger pressure and trigger work of the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 3 to 5 L/min) were significantly less than those of the "automatic adjustment mode" group, and the trigger delay time, trigger work of the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 8 to 9 L/min) were significantly higher than those of the "automatic adjustment mode" group; While for ventilator of "VENT", compared with the inspiratory trigger sensitivity of the "automatic adjustment mode" group and the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 4 arbitrary unit), the trigger delay time, trigger pressure and trigger work were not statistically significant. In case of small air leakage, for ventilator of "A40", the trigger delay time and trigger work of the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 2 to 6 L/min) were significantly less than those in the "automatic adjustment mode" group, and the trigger pressure of "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 2 to 5 L/min and 7 L/min) was significantly lower than that of "automatic adjustment mode" group. While for ventilator of "VENT", the trigger delay time, trigger pressure and trigger work of the "manual adjustment" group (the inspiratory trigger sensitivity was adjusted to 1 to 2 arbitrary unit) were less than those of the experimental group, and they were statistically significant. Conclusions In case of large air leakage, ventilator of "VENT" can not provide breathing assistance ventilation no matter which inspiratory trigger mode. While ventilator of "A40" should be used the "manual adjustment mode", and adjust the inspiratory trigger sensitivity to the less sensitive arbitrary unit to increase its performance of anti-interference. In case of medium air leakage, for both ventilator of "A40" and ventilator of "VENT", it is better to use "automatic adjustment" mode for breathing assistance ventilation. In case of small air leakage, for both ventilator of "A40" and ventilator of "VENT", it is better to use "manual adjustment" mode for breathing assistance ventilation and we should adjust the inspiratory trigger sensitivity to the higher sensitive arbitrary without auto-triggered cycle.
目的:组织瓣修复缺损是头颈部肿瘤切除术中的重要手段和必要环节。本研究总结65例颊癌和口咽癌不同范围组织缺损用局部带蒂组织瓣的修复方法。方法: 回顾2001~2009年我科65例口腔颊癌及口咽癌切除术后选择腭瓣、颏下瓣、面动脉逆行皮瓣、颊脂垫颊肌复合瓣修复颊部及口咽部组织缺损,病变范围和治疗结果。结果: 65例皮瓣中,17例腭瓣全部成活,29例颏下瓣26例全部成活,2例部分坏死,1例表层皮肤坏死, 7例面动脉逆行皮瓣6例全部成活,1例坏死,12例颊脂垫或颊脂垫颊肌复合瓣全部成活11例,1例部分坏死,总成活率96.9％。31例患者术后有不同程度的张口受限,咀嚼和吞咽功能基本正常。结论: 根据颊癌和口咽癌的病变范围决定采用不同的临近带蒂组织瓣修复缺损,修复效果确切,可以明显减少手术创伤和术后并发症,尤其适用于年老及较多基础疾病患者,仍应作为头颈部肿瘤术后缺损修复的重要方法。
An 82-year-old male was hospitalized complaining of dyspnea for 1 year and aggravating for 2 weeks. He had been treated in other hospitals for several times due to such situation and his symptom could be relieved by diuretics. After admission, he was diagnosed as severe aortic stenosis with extremely low left ventricular contractile function; transthoracic echocardiography showed a left ventricular ejection fraction of only 16.1%. He was classified as a typical case of severe aortic stenosis with “low transaortic velocity and low transaortic gradient” since the transaortic velocity being 2.36 m/s and transaortic gradient being 22/14 mm Hg (1 mm Hg=0.133 kPa). Dobutamine-stress echocardiography suggested that the patient’s left ventricular reserve function was extremely poor and the potential benefits of valvular surgery were finite as the former data being 2.59 m/s and 27/16 mm Hg respectively. In consideration of progressive exacerbation of the patient’s symptoms, we eventually conducted transcatheter aortic valve replacement surgery with the support of extracorporeal membrane oxygenation. His symptoms such as dyspnea disappeared after the surgery and clinical parameters had also got a significant improvement.
Objective To design and construct the eukaryotic expressed vector of suicide genes, which contained 5 copies of hypoxia-responsive element (5HRE), promoter of alpha-fetoprotein gene (AFPp） and nitroreductase from Escherichia coli. Methods The constructing processes were as follows: ①The design of primer: Suicide genes of NTR in the Escherichia coli, which contained 6his-tag gene (6his-tag), were cloned by overlapping PCR. ②The construction of 5HRE: The single strand of synthetized HRE oligonucleotide was annealed, and 5HRE was constructed by multiple recombinant clone. ③The recombination of NTR gene, 5HRE, AFPp and pIRES2-EGFP: pIRES2-EGFP, which had removed the instant early promoter of cytomegalovirus, was recombined with NTR gene, 5HRE, AFPp. In this way, the eukaryotic expressed vector of pIRES2-EGFP-5HRE-AFPp-NTR, which carried NTR gene, 5HRE, AFPp was finally constructed. Results NTR gene, which contained the fusion of 684-base pair and 6his-tag gene, was cloned successfully, and its sequence was coincident with the result published by Genbank. A 221-base pair of 5HRE was also constructed, which was in accordance with the expected sequences. The integrity of the eukaryotic expressed vector was verified by restriction enzyme digestion and DNA sequence analysis, respectively. Conclusion The eukaryotic expressed vector of pIRES2-EGFP-5HRE-AFPp-NTR is successfully constructed, which may be used for its further investigation in vitro.
ObjectiveTo observe the clinical effects, advantages, and disadvantages of a new penile circumcision and suturing device in circumcision, by comparing it with traditional circumcision and circumcision with Shang Ring.MethodsThe clinical data of 397 outpatients who underwent surgery for redundant prepuce or phimosis between February 2016 and February 2018 in the Third Affiliated Hospital of Zunyi Medical University were retrospectively collected. The patients chose their surgical types in accordance with the principle of voluntary, with 134 cases undergoing traditional circumcision (the traditional circumcision group), 153 cases undergoing circumcision with Shang Ring (the Shang Ring group), and 110 cases undergoing circumcision with the new penile circumcision and suturing device (PCSD group). The safety, clinical efficacy, and complications among the three groups were compared.ResultsThere were significant differences in postoperative pain scores (F=86.901, P<0.001), edema scores (F=315.656, P<0.001), and appearance scores (F=230.952, P<0.001) among the three groups, and the pain, edema, and appearance scores were significantly better in the PCSD group than those in the traditional circumcision group (P<0.05) and the Shang Ring group (P<0.05). The differences among the three groups in the postoperative pain relief time (F=236.622, P<0.001), intraoperative bleeding volume (F=115.375, P<0.001), edema subsiding time (F=75.614, P<0.001), operation time (F=965.420, P<0.001), and incision healing time (F=42.584, P<0.001) were statistically significant, and the PCSD group was superior to the traditional circumcision group (P<0.05) and the Shang Ring group (P<0.05) in pain relief time, edema subsiding time, and incision healing time. The incidence of postoperative complications in the PCSD group was significantly lower than that in the traditional group and the Shang Ring group (χ2=21.622, P<0.001; χ2=22.778, P<0.001). However, there was no significant difference in intraoperative bleeding volume or operation time between the Shang Ring group and the PCSD group (P=1.000, 0.379), and no significant difference in the incidence of postoperative complications between the traditional circumcision group and the Shang Ring group (χ2=0.014, P=0.912). The proportion of cases undergoing the three surgical methods in each half year changed significantly (χ2=18.721, P<0.001).ConclusionThe use of the new type of penile circumcision and suturing device for circumcision is simple and convenient in clinical operation, with fewer complications, quick recovery, and high satisfaction, and it is worthy of application and promotion.
Polycystic ovary syndrome (PCOS) is a complex and heterogeneous common endocrine disease, and periodontitis is a chronic infectious immune inflammatory disease caused by dental plaque. In recent years, a large number of studies have shown that PCOS and periodontitis may be related, but the pathological mechanism is still unclear. Therefore, this article reviews the correlation between PCOS and periodontitis and the possible biological mechanisms of their mutual influence, in order to provide a theoretical basis for the prevention and treatment of periodontal disease in patients with PCOS.
Objective To summarize the current research advances of colorectal signet-ring cell carcinoma (SRCC). Methods In this paper, the related literatures of colorectal SRCC in recent years were collected and reviewed. Results Colorectal SRCC was a pathological subtype of colorectal adenocarcinoma, with extremely low incidence but high malignancy and poor prognosis. At present, its molecular mechanism was still not very clear and the clinicopathological manifestations were not specific. Surgical treatment was the major treatmen. Conclusions Although we already have a certain degree of understanding about colorectal SRCC, due to the limitations in the results of some related researches because of the small sample size or the single-center study, we still need more researches to improve the cognition of colorectal SRCC.