Partial nephrectomy should be classified as an inpatient procedure: Results from a statewide quality improvement collaborative

ObjectivesTo examine length of stay (LOS) and readmission rates for all minimally-invasive partial nephrectomy (MIPN) and MI radical nephrectomy (MIRN) performed for localized renal masses ≤7 cm in size (cT1RM) within 12 Michigan urology practices. Both RN and PN are commonly performed in treating cT1RM. Although technically more complex and associated with higher complication rates, Centers for Medicare & Medicaid Services considers MIPN an outpatient procedure and MIRN is inpatient.MethodsWe collected data for renal surgeries for cT1RM at MUSIC-KIDNEY practices between May 2017–February 2020. Data abstractors recorded clinical, radiographic, pathologic, surgical, and short-term follow-up data into the registry for cT1RM patients.ResultsWithin MUSIC-KIDNEY, 807 patients underwent MI renal surgery at 12 practices. Median LOS for cT1RM patients after MIPN (n = 531, 66%) was 2 days and after MIRN (n = 276, 34%) was also 2 days. Among patients undergoing laparoscopic or robotic PN, 171 (32%), 230 (43%), and 130 (24%) stayed ≤1, 2, ≥3 days. Among patients undergoing laparoscopic or robotic RN, 81 (29%), 112 (41%), and 83 (30%) stayed ≤1, 2, ≥3 days. No significant difference was observed between MIPN and MIRN on LOS commensurate with outpatient surgery (≤1-day, OR = 0.97, P = 0.87).ConclusionsLess than one-third of patients had a LOS ≤1-day and LOS was comparable for MIPN and MIRN. Centers for Medicare & Medicaid Services should be advised that MIPN is a more complex surgery than MIRN, most patients receiving a MIPN will require a ≥2-day hospital stay and it would be more appropriate to classify MIPN an inpatient procedure with MIRN.     

GK型机械瓣空化可视化研究

对国产GK27型机械二尖瓣进行了单次关闭方式的离体空化实验，采用数码相机拍摄了空泡照片。机械瓣阻塞体关闭后，云状空泡出现在挡座周围，呈放射状向外运动，空化原因是机械瓣关闭时阻塞体与挡座的撞击形成的局部挤压射流，挤压缝隙出口射流速度高达9m/s，局部低压造成空化，在机理上，这是附壁射流引起的旋涡空化。关闭速度是衡量机械瓣空化趋势的重要指标之一。空化历时随心室载荷率的增加而增加，在载荷率为2750mmHg/s时，最大空化历时达440μs。机械瓣空化临界载荷率为420mmHg/s，这比动物实验所得的正常生理条件750mmHg/s低，因此在人体正常生理条件下，机械二尖瓣存在空化的可能。     

Clinicopathologic features and survival of patients with colorectal mucinous, signet-ring cell or non-mucinous adenocarcinoma:experience at an institution in southern China

Background Previous studies have shown conflicting results on the relation between clinicopathologic features and prognosis of patients with colorectal mucinous, signet-ring cell, or non-mucinous adenocarcinoma; only few such studies have been performed in China. This retrospective study analyzed data from our department to investigate clinicopathologic characteristics, prognosis and possible correlations of three histologic types -- colorectal mucinous,signet-ring cell, and non-mucinous adenocarcinoma, to clarity the bases for observed differences which may lead to development of targeted therapies Methods Of 2079 patients diagnosed with colorectal cancer between 1994 and 2007, 144 had mucinous, 25 had signet-ring cell, and 1837 had non-mucinous adenocarcinoma. Their clinicopathologic parameters and survival were analyzed using established statistical methodologies.Results Mucinous and signet-ring cell adenocarcinomas were common in younger patients (P <0.001). Location, size and disease stage differed significantly among the three types. Signet-ring cell tumors were more commonly found in the rectum than mucinous and non-mucinous adenocarcinoma (P <0.001). Mucinous and signet-ring cell tumors presented in a later stage in life more often than non-mucinous adenocarcinoma, with lymph node involvement, serosal infiltration, peritoneal dissemination, and adjacent organ invasion (P <0.01). The rate of radical resection, hepatic metastasis and local recurrence did not differ among types (P ＞0.05). Compared with patients with non-mucinous adenocarcinoma, patients with mucinous and signet-ring cell tumors who underwent potentially curative resections or stage Ⅱ/Ⅲ disease had poorer long-term overall survival. Survival did not differ by type for patients with either stage Ⅰor Ⅳ disease (P ＞0.05). Conclusions Mucinous and signet-ring cell adenocarcinoma have unique carcinogenesis and similar biologic behavior.Our study confirms that both histologic types, especially signet-ring cell tumors, are independent, negative prognostic factors for patients with colorectal cancer. Type does not appear to have a significant effect on survival when disease is either stage Ⅰ or Ⅳ at presentation.     

Early operation for fulminant acute pancreatitis: a possible way to decrease mortality

Background Although the indication and the timing for surgery in fulminant acute pancreatitis (FAP) are still controversial, our experience of surgical treatment for fulminant acute pancreaUtis may help improve the outcome for patients.Methods The clinical data of twenty-six patients with FAP from January 1, 2001 to October 1,2005 were analyzed. The diagnostic criteria fitted the 2007 Guidelines for the Management of Severe Acute Pancreatitis by the Chinese Medical Association.Results Twenty-six patients with FAP received surgical debridement, with a mortality rate of 42.3% (11/26). The postoperative mortalities in the ＞72 hour operation group and the <72 hour operation group were highly significantly different (7/8 vs 22.2% (4/18), respectively).Conclusions Early surgery may reduce the intraabdominal pressure and prevent the deterioration of FAP. An operation within 72 hours from the onset of symptoms might decrease the mortality of the disease.     

Policy making and organization in managing tropical diseases in China

China have a vast territory and a large population. It is situated between north latitude 2°-58° and east longitude 74°-135°. Most of China is lacated in the temperate and subtropical zones, with a small part in the tropical zone. Due to the influence of monsoons from the Pacific Ocean during the summer season, rainfall is plentful, and the weather can be hot and humid. The natural conditions create a good environment for the rise and spread of most tropical diseases (infectious and parasitic diseases), especially in South-eastern China, where about 80% of the population lives.     

导赤散加味治疗慢性前列腺炎110例

目的 了解导赤散加味对慢性前列腺炎的疗效。方法 应用导赤散为主组方,结合直肠指诊、化验检查进行综合分析,辨证加减用药、治疗慢性前列腺炎110例,并与口服环丙沙星片、回通淋丹组40例作对照。结果 治疗组近期治愈率36.4%,总有效率为91.0％,对照组近期治愈率仅15.0%,总有效率为72.5%,两组的有效率比较差异有显性（P＜0．05）。结论 导赤散加味治疗慢性前列腺炎有明显改善作用。     

直视下行大鼠气管插管的改良方法

目的 提高大鼠气管插管的成功率;方法 对比传统闭式法与改良直视法的成功率;结果传统闭式法的成功率为50％,改良直视法的成功率为100％。结论 改良直视法优于传统闭式法,值得推广应用。