Epilepsy is one of the common nervous system diseases in children, due to its complex etiology and diverse seizure types, the current treatment are accompanied by many different side effects. Physical activity refers to any bodily movement that results in energy expenditure above the resting metabolic rate and involves muscle contraction. As a complementary and alternative therapy physical activity has gradually gained attention among epilepsy patients. However, there are still great misconceptions among the society, family members, and even medical personnel about whether children with epilepsy participate in sports, resulting in a low level of physical activity in children and adolescents with epilepsy. Current studies have shown that physical activity has a variety of positive effects, such as the frequency of epileptic seizures, improving the cognitive function of children, and improving the quality of life of patients. It is recommended that children and adolescents with epilepsy should regularly in physical activities to improve their physical and mental health. This article provides a domestic and foreign review from the concept of physical activity, measurement tools, the current situation of physical activity in and adolescents with epilepsy, the positive effect of physical activity on children and adolescents with epilepsy, and the factors affecting physical activity in children and adolescents with epilepsy, etc. in order to provide feasible suggestions for subsequent investigation and research, and to provide reliable basis for the clinical formulation of reasonable individualized programs.
Objective To explore the effect of different nutrition on the immune function of patients with colorectal cancer. Methods A total of 640 colorectal cancer patients were randomized into the enteral nutrition and peripheral nutrition groups. The peripheral venous blood was sampled before operation and on the postoperative days 1 and 7 to determine the serum levels of IgG, IgA, IgM, the percentage of T lymph cell subgroups CD3, CD4, CD4/CD8 and CRP, PGE, α- antitrypsin etc. The patient’s general condition, side-effects, and complications were observed intimately after surgery. Results Compared with the control group, the IgG, IgA, IgM, CD3, CD4,CD4/CD8 levels of the trial group on postoperative day 7 were higher. But the levels of CRP, PGE, α- antitrypsin were decreased. Hospitalization time and anal exsufflation time were shorter as well. There was no significant difference in either the general conditions or complications between the two groups. Conclusion Application of enteral nutrition after colorectal cancer surgery is safe, ,effective, and can improve the patient’s immune function and prognosis.
ObjectiveTo investigate the prevalence of early mobilization and it’s influencing factors in colorectal cancer patients who underwent enhanced recovery after surgery (ERAS) pathway. MethodsThe geneal data and perioperative data were collected through questionnaire survey and accessing to the hospital information system. The situation of early mobilization was investigated by bedside inquiry. Logistic regression was used to analyze the influencing factors of early mobilization in the patients with colorectal cancer. ResultsIn this study, 300 patients with colorectal cancer underwent ERAS were selected. Within 24 h after operation, 47 patients got out of bed, the early mobilization rate was 15.7%. Logistic regression results showed that the patients without preoperative complications (OR=2.726, P=0.019) and without preoperative nutritional risk (OR=3.621, P=0.013), and with operation time <3 h (OR=2.246, P=0.032) increased the probability of early mobilization, and preoperative low albumin decreased the probability of early mobilization (OR=0.364, P=0.007). ConclusionsEarly mobilization rate of patients with colorectal cancer in ERAS mode is low. Preoperative complications, preoperative albumin level, preoperative NRS2002 score, and operation time were important influencing factors. Active treatment of preoperative complications and improvement of preoperative nutritional status could make patients bear follow-up stress process with better physical condition, which helps to promote early mobilization.
Objective To explore the related factors of postoperative pulmonary infection (PPI) in patients undergoing laparoscopic colorectal cancer surgery, and analyze the perioperative management strategy of pulmonary infection combined with the concept of enhanced recovery after surgery (ERAS). Methods Total of 687 patients who underwent laparoscopic colorectal cancer surgery in the colorectal cancer professional treatment group of Gastrointestinal Surgery Center of West China Hospital of Sichuan University from January 2017 to May 2019 were retrospectively included. According to the occurrence of PPI, all the included cases were divided into infection group (n=97) and non-infection group (n=590). The related factors and prevention strategies of PPI were analyzed. Results The rate of PPI among patients underwent laparoscopic resection in our study was 14.1% (97/687). Compared with the non-infection group, the proportions of patients with preoperative complications other than cardiopulmonary, receiving preoperative neoadjuvant radiotherapy and/or chemotherapy, preoperative Eastern Cooperative Oncology Group (ECOG) score 1–2, preoperative Nutrition Risk Screening 2002 (NRS2002) score 1–3, tumor located in the left colon and rectum, combined organ resection, operative time >3 h and postoperative TNM stage Ⅱ patients in the infection group were higher (P<0.05). However, the proportions of patients who used intraoperative lung protective ventilation strategy and incision infiltration anesthesia in the infection group were lower than those in the non-infection group (P<0.05). In the infection group, the proportions of patients who received regular sputum excretion, atomization therapy, balloon blowing/breathing training, stomatology nursing after operation and postoperative analgesia were all significantly lower than those of the non-infection group (P<0.05), whereas the proportions of patients receiving antibiotics and intravenous nutrition after operation were significantly higher than those in the non-infection group (P<0.05). Logistic regression analysis showed that low preoperative NRS2002 score, intraoperative protective ventilation strategy, postoperative respiratory training, and postoperative regular sputum excretion were the protective factors of PPI, while preoperative cardiopulmonary complications, preoperative neoadjuvant chemotherapy, tumor located in the left colon and rectum, late TNM staging and postoperative antibiotics were risk factors for pulmonary infection.Conclusions Preoperative cardiopulmonary complications, preoperative neoadjuvant chemotherapy, tumor location in the left colon and rectum, late TNM staging and postoperative antibiotics are risk factors for pulmonary infection in patients with laparoscopic colorectal cancer. Preoperative good nutritional status, intraoperative protective ventilation strategy, postoperative respiratory training and regular sputum excretion may reduce the incidence of PPI to a certain extent.
目的:探讨公共突发事件中大批量收治伤员时的骨科护理管理流程。方法:对汶川地震期间,四川大学华西医院骨科收治1 410名骨科地震伤员时包括紧急组织管理、护理人力资源管理、护理流程革新以及信息管理等的护理管理进行总结、分析、评价。结果:通过高效的护理应急管理,保证了在汶川地震灾害救援中的医疗、护理质量,提高了伤员的整体救护水平。结论:医院建立有效的应急管理体系,通过各部门配合,再造护理管理流程,在灾害医疗救援中具有重要意义。
The 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease not only updates aortic valve stenosis, mitral regurgitation, prosthetic valves, infective endocarditis and antithrombotic treatment on the basis of the 2017 guidelines update for valvular heart disease, but also involves aortic valve regurgitation, bicuspid aortic valve, mitral stenosis, tricuspid regurgitation, combined valve disease, pregnancy with valvular disease, valve disease complicated with coronary heart disease, valve disease complicated with non-cardiac surgery and the prospect of comprehensive management of valve disease. It covers a wide range of contents, which are introduced in detail and comprehensively. This paper interprets some highlights and core issues, including the top 10 take-home messages, the severity of valvular heart disease, and the updates in the management of aortic valve stenosis, aortic valve regurgitation, bicuspid aortic valve, mitral stenosis and mitral regurgitation.
ObjectiveTo understand the current situation of unplanned readmission of colorectal cancer patients within 30 days after discharge under the enhanced recovery after surgery (ERAS) mode, and to explore the influencing factors.MethodsFrom May 7, 2018 to May 29, 2020, 315 patients with colorectal cancer treated by Department of Gastrointestinal Surgery, West China Hospital, Sichuan University and managed by ERAS process during perioperative period were prospectively selected as the research objects. The general data, clinical disease data and discharge readiness of patients were obtained by questionnaire and electronic medical record. Telephone follow-up was used to find out whether the patient had unplanned readmission 30 days after discharge and logistic regression was used to analyze the influencing factors of unplanned readmission within 30 days after discharge.ResultsWithin 30 days after discharge, 37 patients were admitted to hospital again, the unplanned readmission rate was 11.7%. The primary cause of readmission was wound infection. Logistic regression analysis showed that the body mass decreased by more than 10% in recent half a year (OR=2.611, P=0.031), tumor location in rectum (OR=3.739, P=0.026), operative time ≤3 hours (OR=0.292, P=0.004), and discharge readiness (OR=0.967, P<0.001) were independent predictors of unplanned readmission.ConclusionsUnder the ERAS mode, the readmission rate of colorectal cancer patients within 30 days after discharge is not optimistic. Attention should be focused on patients with significant weight loss, rectal cancer, more than 3 hours of operative time, and low readiness for discharge. Among them, the patient’s body weight and discharge readiness are the factors that can be easily improved by clinical intervention. It can be considered as a new way to reduce the rate of unplanned readmission by improving the patients’ physical quality and carrying out discharge care program.
Continuous activation of Janus kinase (JAK)- signal transduction and activator of transcription (STAT) signaling pathway is prevalent in leukemia cells, and it has been found that this pathway plays an important role in acute leukemia (AL). JAK2/JAK1 gene mutations are found in both acute myelocytic leukemia and acute lymphoblastic leukemia and may have implications for the treatment and overall prognosis of the disease. Among the STAT family members, STAT3 and STAT5 proved to be key factors in AL. These gene mutations may provide new targets and new ideas for the treatment of AL. This article provides a review of the research progress of JAK-STAT signaling pathway, related gene mutations and AL.
Objective To compare the positive rate of zinc finger protein A20， NF-κB p65 protein， and P-glyco- protein between primary hepatocellular carcinoma （HCC） tissues and paratumor tissues， and to explore the relationship between the 3 kinds of proteins and pathological features of HCC. Methods Thirty-two HCC tissues and 26 paratumor tissues resected from patients with HCC treated in our hospital from Feb. 2009 to Aug. 2010 were enrolled. Clinical data were also collected from files. The expressions of zinc finger protein A20， NF-κB p65 protein， and P-glycoprotein were tested by immunohistochemistry. Results The positive rate of zinc finger protein A20， NF-κB p65 protein， and P-glycoprotein in HCC tissues were 87.5%（28/32）， 81.3%（26/32）， and 65.6%（21/32）， respectively， which were higher than that in paratumor tissues〔61.5%（16/26）， 34.6%（9/26）， and 30.8%（8/26）， respectively〕， P＜0.05. The three kinds of proteins were all closely related with HbsAg， and zinc finger protein A20 was related with cirrhosis in addition （P＜0.05）. Conclusions The positive rate of zinc protein A20， NF-κB p65 protein， and P-glycoprotein are much higher in primary HCC tissues than that in paratumor tissus， and they may play an important role in preoperative determination of hepatic tumors.
ObjectiveTo explore the correlation between readiness for hospital discharge and short-term quality of life among colorectal cancer (CRC) patients following enhanced recovery after surgery (ERAS) mode.MethodsSurveys of 127 CRC patients following ERAS mode were conducted in the West China Hospital of Sichuan University. The Readiness for Hospital Discharge Scale and EORTC QLQ-C30 Scale were issued at the discharge and 1 month after the operation, respectively.ResultsThe total score of RHDS was 149.43±33.25. The score of global quality of life was 66.80±18.84. Correlation analysis showed that the total score of RHDS was positively correlated with the score of global quality of life (r=0.220, P=0.013), and negatively correlated with the scores of fatigue, nausea and vomiting, pain, loss of appetite (r=–0.304, P=0.001; r=–0.189, P=0.033; r=–0.257, P=0.004; r=–0.254, P=0.004). The score of personal status dimension were positively correlated with the score of global quality of life and emotional function (r=0.213, P=0.016; r=0.197, P=0.027), and negatively correlated with scores of fatigue, pain and insomnia (r=–0.311, P=0.000; r=–0.264, P=0.003; r=–0.257, P=0.004). The score of knowledge dimension was negatively correlated with nausea and vomiting, pain and loss of appetite (r=–0.212, P=0.017; r=–0.182, P=0.040; r=–0.239, P=0.007). The score of coping ability dimension was positively correlated with the score of global quality of life and physical function (r=0.204, P=0.021; r=0.204, P=0.021), while negatively correlated with scores of fatigue, pain, insomnia and loss of appetite (r=–0.349, P=0.000; r=–0.240, P=0.007; r=–0.202, P=0.022; r=–0.201, P=0.024). The score of expected support was positively correlated with the score of global quality of life (r=0.220, P=0.013), and negatively correlated with scores of fatigue and loss of appetite (r=–0.249, P=0.005; r=–0.227, P=0.010).ConclusionsThe short term quality of life among CRC patients following ERAS keeps at upper middle level, and positively correlated with the readiness for hospital discharge. It is suggested that discharge preparation service is of great significance to improve the quality of life of patients.