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BackgroundTourniquet use is ubiquitous in orthopaedic surgery to create a bloodless field and to facilitate safe surgery, however, we know of the potential complications that can occur as a result of prolonged tourniquet time. Experimental and clinical research has helped define the safe time limits but there is not much literature specific to foot and ankle surgery.MethodsA retrospective review of the postoperative course of patients with prolonged tourniquet time (longer than 180 min) for foot and ankle procedures was done. Data related to the patient factors and the surgical procedure was collected. The length of stay, re-admissions and complications were the important indicators of the individual patient’s recovery.ResultsTwenty patients were identified with longer than 180-min tourniquet times for complex foot and ankle procedures. The average uninterrupted tourniquet time was 191 min. Eight of the twenty procedures were revision surgeries. The average length of stay was 3 days and there were no re-admissions within 30 days. Eight patients (40%) had at least one recorded complication. The complications seen in this group were transient sensory loss, wound issues, superficial infection, ongoing pain and non-union.ConclusionsThis case series has not revealed any major systemic complications resulting from the prolonged tourniquet such as pulmonary embolism or renal dysfunction. Unlike past literature on knee procedures with extended tourniquet times, no major nerve palsies were seen in our patient group. Our understanding of the local and systemic effects of tourniquet is not complete and this study demonstrates that the complications do not necessarily increase in a linear fashion in relation to the tourniquet time.  相似文献   
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Background and aimsEtiologic associations between some modifiable factors (metabolic risk factors and lifestyle behaviors) and cardiovascular disease (CVD) remain unclear. To identify targets for CVD prevention, we evaluated the causal associations of these factors with coronary artery disease (CAD) and ischemic stroke using a two-sample Mendelian randomization (MR) method.Methods and resultsPreviously published genome-wide association studies (GWASs) for blood pressure (BP), glucose, lipids, overweight, smoking, alcohol intake, sedentariness, and education were used to identify instruments for 15 modifiable factors. We extracted effects of the genetic variants used as instruments for the exposures on coronary artery disease (CAD) and ischemic stroke from large GWASs (N = 60 801 cases/123 504 controls for CAD and N = 40 585 cases/406 111 controls for ischemic stroke). Genetically predicted hypertension (CAD: OR, 5.19 [95% CI, 4.21–6.41]; ischemic stroke: OR, 4.92 [4.12–5.86]), systolic BP (CAD: OR, 1.03 [1.03–1.04]; ischemic stroke: OR, 1.03 [1.03–1.03]), diastolic BP (CAD: OR, 1.05 [1.05–1.06]; ischemic stroke: OR, 1.05 [1.04–1.05]), type 2 diabetes (CAD: OR, 1.11 [1.08–1.15]; ischemic stroke: OR, 1.07 [1.04-1.10]), smoking initiation (CAD: OR, 1.26 [1.18–1.35]; ischemic stroke: OR, 1.24 [1.16–1.33]), educational attainment (CAD: OR, 0.62 [0.58–0.66]; ischemic stroke: OR, 0.68 [0.63–0.72]), low-density lipoprotein cholesterol (CAD: OR, 1.55 [1.41–1.71]), high-density lipoprotein cholesterol (CAD: OR, 0.82 [0.74–0.91]), triglycerides (CAD: OR, 1.29 [1.14–1.45]), body mass index (CAD: OR, 1.25 [1.19–1.32]), and alcohol dependence (OR, 1.04 [1.03–1.06]) were causally related to CVD.ConclusionThis systematic MR study identified 11 modifiable factors as causal risk factors for CVD, indicating that these factors are important targets for preventing CVD.  相似文献   
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目的探讨股神经阻滞联合无止血带技术在全膝关节置换术(TKA)中的应用,并分析其在减轻术后疼痛中的作用及对术后认知功能的影响。方法本院2016年1月至2018年1月行TKA患者251例,男117例,女134例,年龄18~80岁,BMI 16.9~31.7 kg/m~2,ASAⅠ—Ⅲ级,随机分为四组:止血带下膝关节置换+静脉镇痛组(PT1组,n=56);止血带下膝关节置换+股神经阻滞镇痛组(PT2组,n=63);无止血带下膝关节置换+静脉镇痛组(P1组,n=56);无止血带下膝关节置换+股神经阻滞镇痛组(P2组,n=76)。分别于术前1 d、术后1、2、3 d测量术侧大腿中上1/3处周长,并于同时点采集外周静脉血测定白细胞计数(WBC)、中性粒细胞百分比(NEUT%)、C-反应蛋白(CRP)浓度。分别于术前1 d、术后1、2、3、7 d和3个月评测患侧膝关节活动度(AROM),采用视觉模拟疼痛评分法(VAS)评估静息和活动时的疼痛VAS评分。分别于术前1 d、术后1、2、3 d采用蒙特利尔认知评估量表(MoCA)评估患者认知功能,记录术后3 d内认知功能损害发生情况和恶心呕吐(PONV)发生情况。结果术后1、2、3 d PT1组和PT2组大腿周长增加值明显大于P1组和P2组(P0.05)、CRP浓度明显低于P1组和P2组(P0.05)。术后1、2 d PT1和P1组AROM明显小于PT2组和P2组(P0.05),PT1组静息和活动时VAS评分明显高于PT2组、P1组和P2组(P0.05),且P1组活动时VAS评分明显高于PT2组和P2组(P0.05)。术后1 d PT1组和PT2组MoCA评分明显高于P1组和P2组(P0.05)。术后3 d内PT1组和PT2组认知功能损害总发生率明显低于P1组和P2组(P0.05),PT1组和P1组PONV的总发生率明显高于PT2组和P2组(P0.05)。结论持续股神经阻滞联合无止血带技术用于全膝关节置换术,患者术后大腿肿胀及疼痛程度较轻,利于膝关节功能锻炼,关节活动度恢复快,但术后全身炎症反应较重且术后早期认知功能损害发生率增加。  相似文献   
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BackgroundThis study aims to compare the use of one-per-mil tumescent solution (a mixture of epinephrine and 0.2% lidocaine in a ratio of 1:1,000,000 in normal saline solution) and tourniquet to create clear operative fields and to evaluate the functional outcomes after post burn hand contracture surgery.MethodsThe subjects of this randomized controlled trial were divided into one-permil tumescent technique and tourniquet group for a similar surgical procedure. Three independent assessors evaluated the clarity of the operative fields through recorded videos for the first 15 min and the first 10-minute of each hour of the surgery. Functional outcome was evaluated at least three months postoperatively using total active and passive motion (TAM and TPM) of each digit. Malondialdehyde (MDA) and tumor necrosis factor alpha (TNF-α) were tested during baseline (5 min before the procedures), ischemia phase, and reperfusion phase (a phase when the blood flow returned to the tissue).Results35 subjects were included in this study: 17 in the tumescent group and 18 in the tourniquet group. We found a significant difference in the clarity of operative field between tumescent and tourniquet groups, 5 vs 35 bloodless operative fields, respectively (p < 0.05). TAM and TPM of each digit before surgery and 3 months postoperatively showed no significant difference between both groups (p > 0.05). Furthermore, we found no difference in MDA and TNF-α levels between both groups at their respective phases.ConclusionsThe use of one-per-mil tumescent technique does not replace tourniquet use to create bloodless operative fields in burned hand contracture surgery. However, the postoperative functional results were similar in both groups showing that tumescent technique can be used as an alternative to tourniquet without compromising outcomes. The MDA and TNF-α examinations do not provide conclusive outcomes regarding ischemia and reperfusion injury.  相似文献   
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Cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC) is the fourth commonest female malignancy worldwide. CESC progresses in immune-microenvironment mainly composed of infiltrating immune and stromal cells. Here, we performed an integrated analysis incorporating the expression profiles from the Cancer Genome Atlas (TCGA) database and scores of immune and stromal cells calculated by Estimation of Stromal and Immune cells in Malignant Tumours using Expression data (ESTIMATE) algorithm. A two-gene signature (CD1C and CD6 genes) was established to predict the prognosis of CESC. Based on this signature, patients were divided into the high- and low-risk groups, and this signature showed good prognostic performance according to the results of Kaplan-Meier analysis and receiver operating characteristic (ROC) analysis in train set and two validation sets. A nomogram was built for evaluating the clinical applicability of this signature. In addition, based on Tumor Immune Estimation Resource (TIMER) database, 2 hub genes showed negative correlations with tumor purity and positive correlations with infiltrating levels of immune filtrating cells. What’s more, we propose new treatment strategies for the two prognostic subtypes. Low- risk patients were found presenting with a higher level of immune checkpoint molecules and showing higher immunogenicity in immunophenoscore (IPS) analysis, which indicated a better response for immunotherapy. Meanwhile, estimated by Genomics of Drug Sensitivity in Cancer (GDSC) database, the high-risk patients showed sensitive responses to five chemotherapy drugs. Finally, 10 candidate small-molecule drugs for CESC were defined. In summary, the CD1C-CD6 signature can accurately predict the prognosis of CESC.  相似文献   
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王孝琪  李云芳  李维华 《全科护理》2020,18(13):1647-1650
[目的]调查护士使用多参数监护仪各重点实践环节规范性,发现使用中可能导致病人安全风险的不规范操作,分析相关因素并提出安全对策。[方法]采用自行编制的调查问卷对162名护士进行调查,对护士一般资料、监护仪使用各重点环节得分进行统计描述和单因素方差分析,并针对问题环节及相关因素提出安全对策。[结果]护士使用多参数监护仪重点实践环节总得分为(72.39±6.93)分,得分率为72.39%。各重点环节得分率最高的是监护仪设置(84.42%),最低的是持续使用监护仪,仅为57.25%,其中定时更换电极片得分率最低(39.25%)。单因素方差分析结果表明不同年龄、护龄、职称、科室对重点实践环节总得分比较差异有统计学意义(P<0.05)。针对出现的问题提出制定统一监护仪操作规范,加强护士培训,完善监护仪使用相关管理措施等病人安全对策。[结论]目前护士使用监护仪存在诸多不规范环节,易造成监护仪使用相关病人安全风险,需积极制定并实施安全对策。  相似文献   
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周培  袁静  丛林  魏兆莲 《安徽医学》2020,41(12):1387-1389
目的 探讨超声引导下胎儿心肌壁注射氯化钾(KCl)在中孕期双绒毛膜双羊膜囊双胎妊娠KCl减胎术中的手术效果。方法 回顾性分析2017年9月至2020年1月安徽医科大学第一附属医院收治的因中孕期双绒毛膜双羊膜囊双胎妊娠伴有双胎之一异常行KCl减胎术的27例孕妇临床资料。根据术中KCl注射部位不同将研究对象分为心腔内注射组(超声引导下胎儿心腔内注射KCl)13例及心肌壁注射组(超声引导下胎儿心肌壁注射KCl)14例。比较两组手术时间、KCl用量和围产儿结局的差异。结果 心腔内注射组手术时间为(33.69±2.46)min,长于心肌壁注射组的(19.86±1.51)min,差异有统计学意义(P<0.05);心腔内注射组KCl用量为(6.00±0.71)mL,多于心肌壁注射组的(2.79±0.54)mL,差异有统计学意义(P<0.05);分娩28天后电话随访,两组孕妇的分娩孕周及新生儿体质量比较,差异均无统计学意义(P>0.05)。结论 在中孕期KCl减胎术中,心肌壁注射KCl较传统的心腔内注射KCl手术耗时更少,KCl用量更少,且不影响保留胎儿的分娩孕周及新生儿出生体质量。  相似文献   
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