Serum selenium and zinc levels in critically ill surgical patients

Purpose

The authors designed this study to determine how serum selenium and zinc affect the outcomes of critically ill surgical patients.

Methods

The medical records of 162 patients admitted to a surgical intensive care unit (ICU) from October 2010 to July 2012 and managed for more than 3 days were retrospectively investigated.

Results

Overall, the mean patient age was 61.2 ± 15.0 years, and the median ICU stay was 5 (3-115) days. The mean Acute Physiologic and Chronic Health Evaluation II score was 18.0 ± 8.0. Eighteen (11.1%) of the study subjects died in ICU. mean selenium levels were 83.5 ± 23.8 ng/dL in the survivor group and 83.3 ± 29.6 ng/dL in the nonsurvivor group, and corresponding mean zinc levels were 46.3 ± 21.7 and 65.6 ± 41.6 μg/dL, respectively. Mean selenium concentrations were significantly different in patients with and without shock (77.9 ± 25.4 and 87.2 ± 23.1 ng/dL, P = .017). Furthermore, mean serum selenium was lower in patients with sepsis than in traumatic or simply postoperative patients (P < .001 and P = .038). Serum Zn was significantly lower in patients with sepsis than in patients with trauma (43.4 ± 25.4 μg/dL vs 54.8 ± 28.1 μg/dL, P = .038).

Conclusions

To determine the effects of serum selenium and zinc levels on critically ill surgical patients, a large-scale prospective study is needed.     

A biomechanical investigation of vertebral staples for fusionless scoliosis correction

Background

Fusionless scoliosis surgery is an early-stage treatment for idiopathic scoliosis which claims potential advantages over current fusion-based surgical procedures. Anterior vertebral stapling using a shape memory alloy staple is one such approach. Despite increasing interest in this technique, little is known about the effects on the spine following insertion, or the mechanism of action of the staple. The purpose of this study was to investigate the biomechanical consequences of staple insertion in the anterior thoracic spine, using in vitro experiments on an immature bovine model.

Methods

Individual calf spine thoracic motion segments were tested in flexion, extension, lateral bending and axial rotation. Changes in motion segment rotational stiffness following staple insertion were measured on a series of 14 specimens. Strain gauges were attached to three of the staples in the series to measure forces transmitted through the staple during loading. A micro-CT scan of a single specimen was performed after loading to qualitatively examine damage to the vertebral bone caused by the staple.

Findings

Small but statistically significant decreases in bending stiffness (P < 0.05) occurred in flexion, extension, lateral bending away from the staple, and axial rotation away from the staple. Each strain-gauged staple showed a baseline compressive loading following insertion which was seen to gradually decrease during testing. Post-test micro-CT showed substantial bone and growth plate damage near the staple.

Interpretation

Based on our findings it is possible that growth modulation following staple insertion is due to tissue damage rather than sustained mechanical compression of the motion segment.     

胃癌腹腔镜根治术的现状及其临床研究进展

随着腹腔镜技术的发展,现阶段研究认为腹腔镜技术在胃癌的治疗可达到与开腹胃癌根治术相同的手术范围,不但可对癌变组织进行切除,还能对淋巴结进行有效的清扫,而且较传统手术具有创伤小、恢复快、术后生活质量高等优点,这不但是微创外科研究的热点,也是临床外科医师不断追逐的目标。本文就腹腔镜技术在胃癌的诊断以及早期、进展期的手术治疗以及并发症的发生等作一综述。     

Effectiveness of surgical resection for complicated liver cancer and its influencing factors: A retrospective study

BACKGROUND Surgical resection is the preferred method for patients with complex liver cancer.But the tumor is in a special position,the surgery is highly risky,postoperative complications can easily occur,and the prognosis is not ideal.AIM To investigate the effectiveness of surgical resection for complex liver cancer and its influencing factors.METHODS Fifty-seven patients who had complicated liver cancer and underwent surgical resection at our hospital from August 2015 to August 2016 were enrolled in this study.All patients were followed for three years,and their postoperative complications,survival,and factors that impacted their survival were analyzed.RESULTS The total incidence of postoperative complications was 45.61%,and the incidence of pleural effusion was the highest at 28.07%.There were no correlations between the 2-year and 3-year survival rates and sex,age,and HbsAg of the patients(P>0.05).In terms of pathological parameters,the 2-year and 3-year survival rates were significantly different according to the presence of a tumor capsule,degree of liver cirrhosis,satellite or focal lesions,hepatic vein thrombosis,portal vein tumor thrombus,and intraoperative blood loss(P<0.05).CONCLUSION be affected by factors such as the presence of a tumor capsule,cirrhosis degree,satellite or focal lesions,hepatic vein embolization,portal vein tumor thrombus,and intraoperative blood loss.Therefore,these factors should be controlled and prevented during surgery to help improve patient survival after surgery.     

经食管探头行心外膜超声在心脏外科手术中的应用研究

目的：探讨经食管心外膜超声心动图在心脏外科术中监测的操作方法,探索其在多种心脏外科手术中的具体应用价值。方法采用GE公司经食管多平面超声探头,体外循环开放并复跳后行经食管心外膜超声心动图对53例心脏手术患者行术中监测,提供瓣膜功能情况、左心室收缩功能、有无残余分流等信息。结果53例患者均在体外循环复跳后行经食管心外膜超声检查获得满意的图像,无感染、出血、严重心律失常等并发症。5例患者发现左心室壁节段性运动异常给予及时处理;1例患者发现换瓣后机械瓣周残余分流再次转机后分流消失;1例患者三尖瓣成形术后仍为中量反流再次成形反流量减少;2例患者发现室间隔修补术后即刻评价术后残余分流再次修补分流消失。1例肥厚型心肌病左心室流出道梗阻患者,即刻评估流出道血流速度超过正常范围（3.2 m/s）,再次转机手术后流速下降为1.4 m/s,压差降低为8 mmHg（1 mmHg=0.133 kPa）。结论经食管心外膜超声心动图具有操作简便、准确的优势,能够即刻评价手术疗效,在心脏外科手术中具有显著发展前景和重要临床应用价值。     

Chinese herbal medicine therapy and the risk of overall mortality for patients with liver cancer who underwent surgical resection in Taiwan

Liver cancer is the sixth most diagnosed cancer globally, and the second leading cause of cancer-related deaths. Surgical resection is a procedure performed to remove cancerous tissue from the liver. Chinese herbal medicine (CHM) is a complementary natural medicine system widely used for treatment of hepatic diseases in Asian countries. We investigated the effects on overall mortality of long-term use of CHM for treatment of patients with liver cancer who underwent surgical resection at the Taiwan Center for Medicine. We identified 1504 patients with liver cancer who underwent surgical resection. Of these patients, 210 CHM users and 210 non-users were selected, and were matched for age, gender, radiotherapy, and chemotherapy prior to CHM treatment. Chi-squared test, Cox proportional hazard modeling, the Kaplan-Meier method, log-rank test, association rule mining, and network analysis were used as statistical methods in this study. CHM users showed a significantly lower risk of overall mortality than non-users (HR: 0.57, 95% CI = 0.40-0.81; p = 0.0025; multivariate Cox proportional hazard model), and a lower 10-year cumulative incidence of overall mortality (p < 0.05; log rank test). Association rule mining and network analysis suggested that Bai-Hua-She-She-Cao, Ban-Zhi-Lian, and Suan-Zao-Ren were the most effective CHMs. Therefore, we concluded that use of CHM as adjunctive therapy may reduce overall mortality in patients with liver cancer who underwent surgical resection. A list of herbal medicines with potential as future therapeutic interventions to prolong the life-span of patients with liver cancer who underwent surgical resection is also provided.     

右美托咪啶与咪达唑仑用于外科重症监护病房术后机械通气患者镇静的比较研究

目的 研究右美托咪定和咪达唑仑用于外科重症监护病房(SICU)术后机械通气(MV)患者的镇静效果及安全性。方法 选择术后带气管导管人SICU行呼吸机辅助通气患者200例,按随机数字表法分为两组,分别给予咪达唑仑（98例）和右美托咪定(102例)镇静治疗,两组均常规给予芬太尼持续静脉泵入镇痛,根据Prince-Henry镇痛评分调整芬太尼剂量,使疼痛评分维持在1～2分;根据Riker镇静和躁动评分(SAS)调整镇静药剂量,使镇静深度评分控制在2～4分;连续监测记录呼吸机参数、心电图、心率、血压、呼吸、脉搏血氧饱和度,并进行血气分析。观察记录两组药物用量,MV时间,以及低血压、心动过缓、谵妄、恶心等副作用发生率。结果 右美托咪定与咪达唑仑均能使患者达到镇静及镇痛目标评分,右美托咪定组更易唤醒并保持安静。与咪达唑仑组比较,右美托咪定组芬太尼用量(μg．kg-1· h-1)明显减少（0.23±0.13比0.41±0.12,P＜0.01）,MV时间(h)明显缩短(7.20±6.29比12.44±8.96,P＜0.01),低血压发生率(27.45％比11.22％)和心动过缓发生率(24.51％比10.20％)明显升高(均P＜0.05),谵妄发生率明显降低（3.92％比31.63％,P＜0.01）,恶心发生率降低(9.80％比11.22％,P＞0.05)。将右美托咪啶组按是否发生低血压再分为两个亚组分析：低血压与非低血压组间术中失血量(ml/kg)、术中输液量(ml．kg-1．h-1)、术后当日及术后1d血乳酸含量(mmol/L)比较差异无统计学意义（术中失血量：12.79±12.13比13.52±11.62;术中输液量：11.91±4.59比13.09±7.05;术后当日乳酸含量：1.88±1.07比1.71±0.87,术后1d乳酸含量：1.43±0.98比1.37±0.79,均P＞0.05）。结论 右美托咪定用于外科术后MV患者镇静效果满意,易唤醒,谵妄发生率低,可缩短MV时间,减少芬太尼用量约50％,是一种较为理想的SICU镇静剂。但要加强用药期间的监测,防治低血压和心动过缓。     

Examination of the efficacy of olanexidine gluconate for surgical site infections in colorectal cancer elective surgery

IntroductionThe preoperative skin antiseptic, olanexidine gluconate (OLG), which has been available in Japan since 2015, is also known to be effective against methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and Pseudomonas aeruginosa. This study attempted to clarify OLG efficacy against surgical site infections and antiseptic-related adverse events as compared to conventionally used povidone iodine (PVP–I).MethodsPropensity score matching was performed on 307 patients who underwent surgery for colorectal tumors at our hospital. All 116 cases (58 PVP-I cases, 58 OLG cases) who were diagnosed with colorectal cancer were included. We examined surgical site infection rate after disinfection using PVP-I and OLG, length of hospitalization stay (days) after surgery, adverse events associated with antiseptics, and additional medical costs associated with adverse events caused by antiseptics.ResultsThe surgical site infection rate was 8.6% in both the PVP-I and OLG groups, with no significant difference observed. The number of postoperative hospitalization days in the PVP-I group was 12.9 (±6.9) days and 16.4 (±14.6) days in the OLG group, which exhibited no significant difference (p = 0.10). Although no complications due to antiseptics were observed in the PVP-I group, skin-related side effects were observed in 8 patients (13.8%) in the OLG group. The median additional medical cost was 730 [120–1823] yen.ConclusionsOLG was as effective as the conventional PVP-I for surgical site infections during colorectal cancer elective surgery. However, significantly higher skin disorders occurred in OLG, thereby making it necessary to evaluate antiseptic use in conjunction with patient burden.