ACC/AHA classification of coronary lesions reflects medical resource use in current percutaneous coronary interventions

Objectives : The purpose of this study was to investigate the association between ACC/AHA type classification of coronary lesions and medical resource utilization. Background : It is not known whether the classification of coronary lesions by the ACC/AHA system reflects the consumption of medical resources in current percutaneous coronary interventions (PCI). Methods : We identified coronary artery lesions treated with PCI from our PCI database between January 1, 2009 and December 31, 2009. Lesions were classified into type A, type B1, type B2, and type C according to the ACC/AHA definition. Total PCI cost, total contrast volume, and total fluoroscopy time were compared among the groups. Results : A total of 447 lesions were analyzed. The number of type A, type B1, type B2, and type C lesion were 75 (16.8%), 98 (21.9%), 145 (32.4%), and 129 (28.9%), respectively. Total PCI cost for type A, type B1, type B2, and type C lesions were $7,262 ± 1,397, $8,126 ± 1,891, $9,126 ± 3,128, and $13,243 ± 4,678, respectively (P < 0.0001). Total contrast volume and fluoroscopy time were also stratified according to the order of type A, type B1, type B2, and type C lesions (P < 0.0001 for total contrast volume; P < 0.0001 for total fluoroscopy time). Conclusions : Total PCI cost, total contrast volume, and total fluoroscopy time were clearly stratified according to the order of type A, type B1, type B2, and type C lesions. Lesion classification by the ACC/AHA system reflects medical resource use in current PCI. © 2011 Wiley Periodicals, Inc.     

Comparison of Billroth I and Roux-en-Y Reconstruction after Distal Gastrectomy for Gastric Cancer: One-year Postoperative Effects Assessed by a Multi-institutional RCT

Purpose

This randomized, controlled trial evaluated the clinical efficacy of Billroth I (BI) and Roux-en-Y (RY) reconstruction at 1 year after distal gastrectomy for gastric cancer.

Methods

The primary end point was the amount of body weight lost at 1 postoperative year, and secondary end points included other items related to nutritional status such as serum albumin and lymphocyte count, as well as endoscopic examination findings of the remnant stomach and esophagus. Of the 332 patients enrolled, 163 were assigned to the BI group and 169 were randomized to the RY group.

Results

The loss in body weight 1 year after surgery did not differ significantly between the BI and RY groups (9.1 % and 9.7 %, respectively, p = 0.39). There were no significant differences in other aspects of nutritional status between the 2 groups. Endoscopic examination 1 year after gastrectomy showed reflux esophagitis in 26 patients (17 %) in the BI group versus 10 patients (6 %) in the RY group (p = 0.0037), while remnant gastritis was observed in 71 patients (46 %) in the BI group versus 44 patients (28 %) in the RY group (p = 0.0013); differences were significant for both conditions. Multivariable analysis showed that the only reconstruction was the independently associated factor with the incidence of reflux esophagitis.

Conclusions

RY reconstruction was not superior to BI in terms of body weight change or other aspects of nutritional status at 1 year after surgery, although RY more effectively prevented reflux esophagitis and remnant gastritis after distal gastrectomy.     

One-pot synthesis of poly(ionic liquid)s with 1,2,3-triazolium-based backbones via clickable ionic liquid monomers

Clickable α-azide-ω-alkyne ionic liquid monomers were developed and subsequently applied to the one-pot synthesis of ionically conducting poly(ionic liquid)s with 1,2,3-triazolium-based backbones through a click chemistry strategy. This approach does not require the use of solvents, polymerisation mediators, or catalysts. The obtained poly(ionic liquid)s were characterized by NMR, differential scanning calorimetry, thermogravimetric analysis, and impedance spectroscopy analysis. Moreover, these poly(ionic liquid)s were cross-linked via N-alkylation with a dianion quarternizing agent to achieve enhanced ionic conductivity and mechanical strength. The resulting free-standing films showed a Young''s modulus up to 4.8 MPa and ionic conductivities up to 4.60 × 10⁻⁸ S cm⁻¹ at 30 °C. This facile synthetic strategy has the potential to expand the availability of poly(ionic liquid)s and promote the development of functional materials.

Clickable ionic liquid monomers realize the one-pot synthesis of ionically conducting poly(ionic liquid)s with 1,2,3-triazolium-based backbones via click chemistry.     

Predictive Ability of the Five-time Chair Stand Test for Postoperative Pneumonia after Minimally Invasive Esophagectomy for Esophageal Cancer

Annals of Surgical Oncology - The revised sarcopenia guidelines proposed handgrip strength (HGS) and five-time chair stand test (5-CST) as the primary parameters of muscle function. HGS and 5-CST...     

肾清汤灌肠联合结肠透析治疗慢性肾功能衰竭临床研究

目的:观察肾清汤灌肠联合结肠透析治疗慢性肾功能衰竭的临床疗效。方法:将慢性肾功能衰竭患者100例,随机分为治疗组和对照组各50例。对照组给予基础治疗(饮食教育、治疗原发病、控制血压、纠正电解质紊乱及代谢性酸中毒、纠正贫血、调节钙磷代谢、防止感染等);治疗组在对照组的基础上加用肾清汤灌肠联合结肠透析,2组均观察治疗10 d,统计2组临床疗效及不良反应情况,检测2组治疗前后肌酐(SCr)、尿素氮(BUN)、内生肌酐清除率(CCr)、血红蛋白(Hb)、血浆白蛋白(Alb)水平变化。结果:治疗组总有效率为86.0%,对照组为64.0%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组SCr、BUN水平均较治疗前降低(P<0.05),CCr值较治疗前升高(P<0.05);且治疗组各项指标改善较对照组更显著(P<0.05)。治疗后2组患者Alb改善不大,治疗前后及组间比较,差异均无统计学意义(P>0.05)。治疗后,2组患者Hb均较治疗前升高(P<0.05),且治疗组Hb升高较对照组更显著(P<0.05)。治疗组不良反应发生率为26.0%,对照组为18.0%,2组比较,差异无统计学意义(P>0.05)。结论:肾清汤灌肠联合结肠透析治疗慢性肾功能衰竭疗效显著。     

Randomized controlled trial of the LigaSure vessel sealing system versus conventional open gastrectomy for gastric cancer

Purpose

LigaSure, a bipolar electronic vessel sealing system, has become popular in abdominal surgery but few clinical studies have been conducted to evaluate its effectiveness in radical gastrectomy for gastric cancer.

Methods

In this multicenter, prospective, randomized controlled trial, patients with curative gastric cancer were randomly assigned to undergo gastrectomy either with LigaSure or a conventional technique.

Results

Of the 160 patients enrolled, 80 were randomized to the LigaSure group and 78 to the conventional group. Patient characteristics were well balanced in the two groups. There were no significant differences between the LigaSure and conventional groups in blood loss (288 vs. 260 ml, respectively; P = 0.748) or operative time (223 and 225 min, respectively; P = 0.368); nor in the incidence of surgical complications or duration of postoperative hospital stay. In a subgroup analysis of patients who underwent gastrectomy that preserved the distal part of the greater omentum, the use of LigaSure significantly reduced blood loss (179 vs. 245 ml; P = 0.033), and the duration of the operation (195 vs. 221 min; P = 0.039).

Conclusions

LigaSure did not contribute to reducing intraoperative blood loss, operative time, or other adverse surgical outcomes. The usefulness of the device may be limited to a specific part of the surgical procedure in open gastrectomy.     

Inguinal hernia repair with the mesh plug method is safe after radical retropubic prostatectomy

Purpose

We evaluated the safety and efficiency of using the mesh plug method (MP) to repair inguinal hernias in patients with a history of radical retropubic prostatectomy (RRP). We also investigated how RRP influences the development of inguinal hernias and impacts their repair.

Methods

Among 488 adult male patients who underwent inguinal hernia repair during a recent 5-year period, 37 had a history of RRP. We compared the characteristics and surgical outcomes of the patients who had undergone RRP (post-RRP group) with those who had not (non-RRP group).

Results

All post-RRP hernias were treated by MP. The 37 post-RRP patients had a collective 41 hernias, 40 of which were of the indirect type. The side affected by the hernia did not differ significantly between the groups. We compared the short-term surgical outcomes of the indirect post-RRP hernias vs. the indirect non-RPP hernias without recurrence and incarceration. The operation times, postoperative hospital stay, and mobility rates did not differ significantly between the two groups. The blood loss was almost equal in both groups.

Conclusion

Inguinal hernia repair after RRP may be difficult because of inflammatory changes in the preperitoneal cavity, but the surgical outcomes of MP were equivalent in patients with or without a history of RPP in this study. MP is a safe and effective method for post-RPP hernia repair.     

Appropriate Heart Rate in a Patient with Repaired Tetralogy of Fallot

Appropriate heart rate in a failing pulmonary ventricle remains unknown, particularly in congenital heart disease with unique hemodynamics. A 71-year-old male with repaired tetralogy of Fallot and a pacemaker for a sinus node dysfunction suffered from heart failure symptoms with preserved left ventricular function. Simply changing the pacemaker’s lower rate from 60 to 75 bpm, New York Heart Association classification improved from III to II, and hemodynamic parameters drastically improved. We regarded this case as informative. Appropriate heart rate could be higher in congenital patients with failing right and non-failing left ventricles than in adults with malfunctioning LV.     

TB, HIV-associated TB and multidrug-resistant TB on Thailand's border with Myanmar, 2006-2007

Objective To measure the burden and improve management of tuberculosis (TB), HIV‐associated TB and MDR TB in Tak Province, Thailand, which borders Myanmar. Methods From September 2006 to August 2007, we collected uniform data about TB cases and enhanced human immunodeficiency virus (HIV) counselling and testing. We provided mycobacterial culture and drug‐susceptibility testing in public or non‐governmental organization facilities. Patients were classified by nationality and, for non‐Thais, by migration status. Results Of 1662 TB cases in the 12‐month period, 1087 (65%) occurred in non‐Thais. Of non‐Thais, 415 (38%) lived in Myanmar but crossed the border for healthcare. HIV infection was diagnosed in 18% of Thais compared with 12% of non‐Thais (P < 0.01); HIV status was unknown for 22% of Thais and 27% of non‐Thais (P = 0.02). Overall, multidrug‐resistant (MDR) TB was diagnosed in 27 patients, 19 (70%) in non‐Thais. Among TB cases never previously treated for TB, no MDR cases were diagnosed in Thais or in Myanmar refugees, but six cases were diagnosed in migrants from Myanmar. Conclusions In Thailand, TB, HIV‐associated TB and MDR TB in migrants from Myanmar are important public health problems; they need to be resolved in both the countries.