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EH Gemmill DJ Humes JA Catton 《Annals of the Royal College of Surgeons of England》2015,97(3):173-179
Introduction
Fast track methodology or enhanced recovery schemes have gained increasing popularity in perioperative care. While evidence is strong for colorectal surgery, its importance in gastric and oesophageal surgery has yet to be established. This article reviews the evidence of enhanced recovery schemes on outcome for this type of surgery.Methods
A systematic literature search was conducted up to March 2014. Studies were retrieved and analysed using predetermined criteria.Results
From 34 articles reviewed, 18 eligible studies were identified: 7 on gastric and 11 on oesophageal resection. Three randomised controlled trials, five case-controlled studies and ten case series were identified. The reported protocols included changes to each stage of the patient journey from pre to postoperative care. The specific focus following oesophageal resections was on early mobilisation, a reduction in intensive care unit stay, early drain removal and early (or no) contrast swallow studies. Following gastric resections, the emphasis was on reducing epidural anaesthesia along with re-establishing oral intake in the first three postoperative days and early removal of nasogastric tubes.In the papers reviewed, mortality rates following fast track surgery were 0.8% (9/1,075) for oesophageal resection and 0% (0/329) for gastric resection. The reported morbidity rate was 16.5% (54/329) following gastric resection and 38.6% (396/1,075) following oesophageal resection. Length of stay was reduced in both groups compared with conventional recovery groups in comparative studies.Conclusions
The evidence for enhanced recovery schemes following gastric and oesophageal resection is weak, with only three (low volume) published randomised controlled trials. However, the enhanced recovery approach appears safe and may be associated with a reduction in length of stay. 相似文献85.
Extracellular matrix of cultured bovine aortic endothelial cells contains functionally active type 1 plasminogen activator inhibitor 总被引:17,自引:0,他引:17
The extracellular matrix (ECM) of cultured bovine aortic endothelial cells (BAEs) was analyzed by immunoblotting and reverse fibrin autography and shown to contain type 1 plasminogen activator inhibitor (PAI-1). Most PAI-1 in the ECM formed complexes with exogenously added tissue-type plasminogen activator (tPA), demonstrating that this PAI-1 was functionally active. The resulting tPA/PAI-1 complexes were recovered in the reaction solution, indicating that the PAI-1 in such complexes no longer bound to ECM. The PAI-1 could not be removed by incubating ECM in high salt (2 mol/L NaCl), sugars (1 mol/L galactose, 1 mol/L mannose), glycosaminoglycans (10 mmol/L heparin, 10 mmol/L dermatan sulfate), or epsilon-aminocaproic acid (0.1 mol/L). However, PAI-1 could be extracted from ECM by treatment with either arginine (0.5 mol/L) or potassium thiocyanate (2 mol/L), or by incubation under acidic conditions (pH 2.5). ECM depleted of PAI-1 by acid extraction was able to bind both the active and latent forms of PAI-1. In this instance, most of the bound PAI-1 did not form complexes with tPA, indicating that the latent form was not activated as a consequence of binding to ECM. Although the PAI-1 activity in conditioned medium decayed with a half-life (t 1/2) of less than 3 hours, the t 1/2 of ECM- associated PAI-1 was greater than 24 hours. These data suggest that PAI- 1 is produced by cultured BAEs in an active form and is then either released into the medium where it is rapidly inactivated or into the subendothelium where it binds to ECM. The specific binding of PAI-1 to ECM protects it from this inactivation. 相似文献
86.
Why Do Patients of Female Physicians Have Higher Rates of Breast and Cervical Cancer Screening? 总被引:4,自引:0,他引:4
Nicole Lurie MD MSPH Karen L. Margolis MD MPH Paul G. McGovern PhD Pamela J. Mink MPH Jonathan S. Slater PhD 《Journal of general internal medicine》1997,12(1):34-43
OBJECTIVE: Women are more likely to receive breast and cervical cancer screening if they see female physicians. We studied whether this
is due to differences between male and female physicians, or to differences in their patients.
SETTING: Large midwestern, independent practice association style of health plan.
DESIGN: We surveyed male and female primary care physicians matched for age and specialty and a stratified random sample of three
of each physician's women patients. Physicians reported on their practice setting, their attitudes and practices regarding
prevention, and their comfort and skill with various examinations. Patients reported on their sociodemographic characteristics,
their attitudes and practices regarding prevention, and their preferences for physician gender. Claims data were used to calculate
mammography and Pap smear screening rates for the physicians
PARTICIPANTS: We studied 154 female and 190 male internists and family physicians and 794 of their patients.
MEASUREMENTS AND MAIN RESULTS: We compared the responses of male and female physicians and their patients and used multivariable analysis to identify the
patient and physician factors that accounted for the differences in screening rates between male and female physicians. Female
physicians were more likely to ask new patients about components of prevention, to believe in the effectiveness of mammography,
to feel more personal responsibility for ensuring that their patients received screening, and to report more comfort in performing
Pap smears and breast examinations. Patients of female physicians were more educated and less likely to be married, but did
not differ in other sociodemographic characteristics. They had similar attitudes and practices regarding prevention, except
that patients of male physicians were more likely to smoke. Significantly more patients of female physicians preferred a female
for some component of care. In multivariable analyses, practice organization, patient preference for a female physician, and
prevention orientation of female physicians accounted for up to 40% of screening rate differences between female and male
physicians for Pap smears, and 33% for mammography.
CONCLUSIONS: Differences in beliefs of male and female physicians and patient preference for a female provider contribute independently
to the higher rate of breast and cervical cancer screening by female physicians. 相似文献
87.
Eosinophils stimulate fibroblast DNA synthesis 总被引:9,自引:0,他引:9
Fibrosis complicates a number of chronic inflammatory diseases and occurs in some conditions following chronic hypereosinophilic syndromes. We assessed whether eosinophils might be a source of fibrogenic factors. Extracts of human and guinea pig cell populations enriched for eosinophils contained substances that stimulated tritiated thymidine incorporation by human fibroblasts. Supernatants derived from resting eosinophils and extracts prepared from eosinophil granules also contained fibrogenic factors. Our findings demonstrate a new potential role for eosinophils and suggest a causal relationship between tissue eosinophilia and scar formation in certain parasitic conditions. 相似文献
88.
V. I. Guelstein O. Yu. Ivanova L. B. Margolis Ju. M. Vasiliev I. M. Gelfand 《Proceedings of the National Academy of Sciences of the United States of America》1973,70(7):2011-2014
Results of cell-cell collisions were studied with the aid of time-lapse microcinematography in primary cultures of normal mouse-embryo fibroblast-like cells and in cultures of transformed mouse cells of two types: (a) primary fibroblast-like cells transformed by Moloney mouse sarcoma virus; (b) neoplastic fibroblasts of the CIM strain. 相似文献
89.
Histamine reduces boron neutron capture therapy‐induced mucositis in an oral precancer model 下载免费PDF全文
90.
Newly Developed Chronic Conditions and Changes in Health‐Related Quality of Life in Postmenopausal Women 下载免费PDF全文