ObjectiveTo systematically review the protection effect of epidural anesthesia combined with general anesthesia versus general anesthesia alone in patients underwent cardiac surgery, so as to provide evidence for reducing complications of cardiac surgery. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 2, 2015), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about epidural anesthesia combined with general anesthesia versus general anesthesia alone for patients underwent cardiac surgery from inception to February 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software. ResultsA total of 35 RCTs involving 3 311 patients were included. The results of meta-analysis showed that, compared with the general anesthesia group, the combination anesthesia group had lower incidence of supraventricular tachycardias (RR=0.63, 95%CI 0.48 to 0.83, P=0.001) and shorter ICU stay time (SMD=-0.57, 95%CI -1.02 to-0.12, P=0.01), but there were no significant differences in the incidences of respiratory complications, myocardial infarction, stroke and mortality between the two groups (all P values >0.05). ConclusionCurrent evidence shows that the combination of epidural anesthesia and general anesthesia has better protection effect than general anesthesia alone in cardiac surgery, but the influence on long-term prognosis still needs to be assessed. Due to the limited quality of included studies, the above conclusion still needs to be verified by more high quality studies．
ObjectiveTo explore the value of portable ultrasound in assessing peripheral vein thrombosis of the injured in Lushan earthquake on April 20, 2013. MethodsFrom April 20th to May 5th in 2013, 321 earthquake victims were admitted into our hospital, and 203 fractured patients of them accepted peripheral venous two-dimensional and color doppler ultrasound examination beside the bed every three days. ResultsSixty-three patients (82 locations) suffered from venous thrombosis in the 203 earthquake victims, and the rate was 31.03% (63/203). Among them, one suffered from iliac vein thrombosis; 53 patients (71 limbs) were attacked by lower limb venous thrombosis; 9 patients (10 limbs) suffered from upper limb venous thrombosis. The time was from 2 to 15 days after trauma when the victims were diagnosed to have thrombus at the first time, averaging (6.1±3.8) days. On admission day, 45 victims were diagnosed with peripheral vein thrombosis. Among them, 19 patients increased the scope of thrombus after admission in hospital, while 26 victims reduced the scope. Eighteen victims suffered from newly developed peripheral venous thrombus after admission in hospital. None of the hospitalized patients died of pulmonary embolism. ConclusionsThe victims injured in the earthquake have a high incidence of peripheral vein thrombosis, and the calf is the main site of the disease. After trauma, peripheral venous thrombosis occurs within a short time. Bedside portable ultrasound is the first choice for peripheral vein thrombosis in the earthquake victims.
ObjectiveTo explore the effectiveness of modified Politano-Leadbetter reimplantation for the treatment of congenital malformation of the vesicoureteral junction in children. MethodsA retrospective analysis was made on the clinical data of 53 patients with congenital malformation of the vesicoureteral junction treated with modified Politano-Leadbetter reimplantation between June 2000 and October 2014. Of 53 cases, there were 24 boys and 29 girls, aged from 8 months to 7 years (mean, 2.1 years); 23 had congenital vesicoureteral junction obstruction (14 left, 5 right, and 4 bilateral), and 30 had vesicoureteral reflux (12 unilateral, 18 bilateral), which were verified by voiding cystourethrography. The disease duration was from 1 month to 1 year (mean, 5 months). ResultsAll of the patients underwent modified Politano-Leadbetter reimplantation successfully. The mean operation time was 74 minutes (range, 65-85 minutes) for unilateral cases and 105 minutes (range, 98-130 minutes) for bilateral cases. There was no dysuria, infection of incision, or incision dehiscence after urinary catheter removal. The follow-up time was 6 months to 14 years (median, 28 months); all patients were free from complications of fistula, vesicoureteral reflux, vesicoureteral junction obstruction, or hypertension. The new ureteral orifices had good appearance at 1 month after operation. Urologic ultrasound showed that hydronephrosis relieved at 3 months after operation. Urinary tract infection rate was 13.2% (7/53) during 6 months after operation, which was cured by antibiotics. Voiding cystourethrography showed no vesicoureteral reflux in 32 cases at 6 months after operation. ConclusionThe modified Politano-Leadbetter reimplantation simplifies the operation course, which has the longitudinal ureter after operation and is similar to physiological state. It is a safe and effective option for congenital malformation of vesicoureteral junction in children with few complications, especially for patients with unilateral megaloureter.
Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.