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BackgroundClinically relevant postoperative pancreatic fistula and delayed gastric emptying cause substantial morbidity after pancreatoduodenectomy. Per international guidelines, the placement of jejunostomy tubes may be considered for patients at risk for malnutrition, such as those with a high risk for clinically relevant postoperative pancreatic fistula and related complications. This study determined predictors and postoperative outcomes of jejunostomy tube placement.MethodsPatients undergoing pancreatoduodenectomy in 2014 to 2015 were identified using the American College of Surgeons National Surgical Quality Improvement Program and Procedure-Targeted Pancreatectomy Participant Use Files. Multivariable logistic regressions were used to identify factors associated with concurrent jejunostomy tube placement and postoperative outcomes.ResultsOf 3,600 patients, 8.9% underwent jejunostomy tube placement. Patients given a jejunostomy tube were more likely white (odds ratio 1.46, P = .016), to have low preoperative serum albumin levels (odds ratio 2.13, P < .001), to have received neoadjuvant radiotherapy (odds ratio 2.14, P < .001), and to have received an intraoperative transfusion (odds ratio 1.50, P = .004). We observed no association between jejunostomy tube placement and an increasing number of risk factors for clinically relevant postoperative pancreatic fistula (P = .96) or delayed gastric emptying (P = .54). Overall, jejunostomy tube placement was associated with increased morbidity (odds ratio 1.34, P = .020) and duration of stay (P < .001), but not mortality (P = .12). Among patients with low serum albumin or those who developed clinically relevant postoperative pancreatic fistula or delayed gastric emptying, jejunostomy tube utilization was not associated with morbidity or mortality.ConclusionJejunostomy tube placement during pancreatoduodenectomy was not driven by risk factors for clinically relevant postoperative pancreatic fistula or delayed gastric emptying, suggesting that practice patterns play a role. Among patients with at-risk preoperative albumin or who developed these complications, jejunostomy tube placement was not associated with worse outcomes, supporting selective utilization per guideline recommendations.  相似文献   
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IntroductionProstaglandin E1 (PGE1) administered to patients in the immediate post-transplant period has been known to reduce ischemic reperfusion injuries (IRIs), but the effect on IRI of PGE1 administered to the donor is unknown. The purpose of this study was to determine the effect on IRI of PGE1 injected into donor rats during heterotopic heart transplantation.MethodsGenetically identical male Sprague Dawley rats with a body weight of 300–320 g at 8–9 weeks of age were used for the study. Experimental methods were the same in the control (G0, n = 6) and experimental groups (G1, n = 6), but only the donor rats in the experimental group received an intramuscular injection of PGE1 (5 μg/kg) prior to the donor surgery. On day 1 the animals were sacrificed with the removal of the transplanted heart. Histologic analysis was performed in the hematoxylin-eosin-stained slides to assess interstitial edema and neutrophil infiltration by a pathologist.ResultsMedian times of the donor organ procurement, cold ischemia, and warm ischemia were 37, 69, and 35 minutes, respectively, in the G0 group and 38, 76.5, and 33 minutes respectively in G1 group; there were no statistical differences. Heartbeats were observed in the transplanted graft in 2 of the G0 group and 2 of G1 group immediately after heart transplantation, but in all transplanted grafts on day 1 after surgery. Histologic scores for neutrophil infiltration showed significantly lower in the G1 group than in the G0 group.ConclusionPGE1 administration to donors in a rat heart transplantation model may significantly reduce IRI.  相似文献   
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基于五运六气理论,尤其是三年化疫理论,对当前正在流行的新型冠状病毒感染的肺炎进行病因病机分析及分期诊疗指导。  相似文献   
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正With the ever increasing application of electronic technology,our exposure to artificial electromagnetic energy is also rapidly increasing.Electromagnetic radiation(EMR)is the fourth largest source of pollution,after air,water,and noise~([1]).All populations are now exposed to varying degrees of EMR,and this poses a serious public health threat.The human level of exposure to EMR will continue to increase as technology advances and becomes an  相似文献   
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厌食是小儿时期常见的脾胃病症,本文介绍了应用运脾散神阙穴贴敷治疗厌食症67例,取得满意疗效。  相似文献   
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【目的】观察崔氏术后饮对经皮肾镜碎石取石术(PCNL)患者术后胃肠功能恢复的影响。【方法】将100例PCNL术后患者随机分为中药组和对照组,每组各50例。对照组术后给予抗感染、补液等基础治疗,中药组在基础治疗的同时给予崔氏术后饮治疗,于术后第1天开始服用,连续治疗1周或至出院前。观察2组患者术后首次肛门排气时间、首次排便时间及术后住院时间,并于术前1天和术后第1天、第3天对2组患者进行疲劳程度视觉模拟量表(VAS)评分,于术后第1天、第2天、第3天对2组患者进行胃肠功能恢复总体疗效评分。【结果】(1)中药组患者的首次排气时间、首次排便时间及术后住院天数均较对照组明显缩短,差异均有统计学意义(P<0.05或P<0.01)。(2)术后第1天,2组患者胃肠功能恢复总体疗效评分比较,差异无统计学意义(P>0.05);术后第2天和第3天,中药组患者的胃肠功能恢复总体疗效评分均较对照组明显提高,差异均有统计学意义(P<0.05或P<0.01)。(3)术后第1天,2组患者的疲劳程度VAS评分均较术前1天明显升高(P<0.05),但组间比较,差异无统计学意义(P>0.05);术后第3天,2组患者的疲劳程度VAS评分均较术后第1天明显降低(P<0.05),且中药组患者的疲劳程度VAS评分明显低于对照组,差异有统计学意义(P<0.05)。【结论】崔氏术后饮能有效促进PCNL术后胃肠功能恢复,显著改善术后疲劳症状,缩短术后住院天数。  相似文献   
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苏颖 《吉林中医药》2014,(1):12-14,73
刘温舒,北宋哲宗文官朝散郎,任大医学司业。于北宋元符二年即公元1099年撰《素问入式运气论奥》3卷。该书阐述五运六气之理,解惑分图,推究五运六气的本源,是五运六气研究史上的重要著作之一。对传承五运六气之学、运用图表概释运气规律、引经据典阐述天地造化之理等3个方面的研究表明,《素问入式运气论奥》是中医运气学史上的重要著作。其对于研究天地阴阳变化之理,探索自然规律的恒动性与规律性,解释五运六气经典问题具有重要价值。其中还有很多重要的观点值得深入研究。  相似文献   
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目的:探讨养阴润目方治疗干眼症的临床疗效。方法:100例干眼患者按随机数字表法分为观察组和对照组各50例,对照组指导使用泪然眼药水,观察组给予养阴润目方加减,随访观察疗效。结果:观察组和对照组治疗总有效率分别为86%、44%,比较差异有统计学意义(P<0.01);观察组治疗后泪液分泌量明显增多,BUT明显延长,与治疗前和同期对照组比较有显著性差异(P<0.01)。结论:养阴润目方是治疗干眼症的有效方剂,值得临床推广应用。  相似文献   
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