慢性难愈合创面住院患者回顾性调查

目的 了解慢性难愈合创面形成原因及患者相关情况,为该类创面的治疗、研究提供方向,为国家相关部门制定健康保障策略提供依据.方法收集2008年武汉市第三医院全院共12 161例次住院患者病历资料.以皮肤组织缺损经1个月治疗未愈合为判定标准,筛选出慢性难愈合创面患者病历,回顾性调查患者创面形成原因、性别、年龄、治疗情况、平均住院日.对数据行x2检验和方差分析.结果 12 161例次住院患者中,慢性难愈合创面患者397例次占3.3%.(1)创面的主要形成原因为烧伤占59.9%(238/397)、糖尿病占15.6%(62/397)、压疮占10.8%(43/397),其次为手术、感染、静脉曲张等.各种原因引起慢性难愈合创面患者例次比较,差异有统计学意义(x2=136.21,P=0.001).(2)慢性难愈合创面患者男、女比例为2.0∶1.0;年龄(44±23)岁,高发年龄段为大于或等于70岁,各年龄段创面患者例次比较,差异有统计学意义(x2=24.12,P=0.025).各种原因引起的慢性难愈合创面患者各年龄段例次比较,差异均有统计学意义(x2值为7.86～28.31,P值均小于0.05).(3)分别有60.5%(240/397)和86.4%(343/397)的慢性难愈合创面患者接受了手术与抗生素治疗,所有患者均采用传统敷料治疗.(4)慢性难愈合创面患者平均住院日为(38±27)d,较同期所有住院患者明显延长[(15±7)d,F=22.82,P=0.012].烧伤引起的慢性难愈合创面患者平均住院日[(47±27)d]最长,各种原因引起的慢性难愈合创面患者平均住院日比较,差异有统计学意义(F=24.06,P=0.036).结论烧伤及糖尿病引起的慢性难愈合创面较多,创面患者老龄化明显、住院时间明显长于其他疾病患者.有必要加大转化医学研究力度,促进国家相关政策制定,使慢性难愈合创面得到科学合理的治疗.

Abstract：

Objective To investigate cause of chronic wounds and related status of patients so as to provide strategy for study and treatment of chronic wounds and establish ment of health policy. Methods A total of twelve thousand one hundred and sixty-one cases hospitalized in our hospital in 2008 were enrolled in the study. A chronic wound was defined as skin tissue defect which could not heal after one month of treatment. Medical records were thus screened. Then a retrospective study was performed on patients with chronic wounds with analysis of age, gender, injury cause, therapy, and average length of hospital stay. Data were processed with chi-square test and one-way analysis of variance. Results Investigation showed:397 out of 12 161 cases ( accounting for 3.3% ) were recognized as having chronic wounds. ( 1 ) The main causes for chronic wound were burn, diabetes, and pressure ulcer, accounting for 59.9% (238/397),15.6% (62/397), 10.8% (43/397), respectively. The other causes were operative injury, infection,varicosity, etc. There was statistical difference among the numbers of patients with chronic wounds with regard to various causes of injury (x 2 = 136.21, P = 0. 001 ). (2) Among patients with chronic wound, the patients older than 70 years. There was significant difference in the numbers of patients with chronic wound among different age groups (x2 = 24.12, P =0. 025). There was statistical difference among the numbers of patients with chronic wound in different age groups with each cause of injury ( with x 2 values from 7.86 to 28.31, P values all below 0.05 ). ( 3 ) All patients with chronic wounds received traditional dressing. In 60. 5% (240/397) and 86.4% (343/397) of patients, operative treatment or antibiotics were given. (4)The average length of hospital stay in patients with chronic wound [( 38 ± 27 ) d] was longer as compared with that of all the inpatients in the same period [(15 ± 7) d, F = 22.82, P = 0. 012]. There was obvious difference in the average length of hospital stay among patients with chronic wound caused by different reasons ( F = 24.06, P = 0. 036) , in which burn injury resulted in the longest length of hospital stay [(47 ±27) d]. Conclusions Chronic wounds are mainly caused by diabetes and burn, and characterized by old age and longer length of hospital stay. It is necessary to strengthen translational research and related policy making, so that more rational treatment can be applied for patients with chronic wounds.     

小剂量乌拉地尔对单肺通气期间动脉氧合及血流动力学的影响

目的 观察小剂量乌拉地尔对单肺通气(OLV)期间动脉氧合及血流动力学的影响.方法 择期行食管癌根治术患者100例,随机均分为两组,分别在OLV期间持续静脉输注乌拉地尔4 μg· kg-1 ·min-1(U组)和等容量生理盐水(C组).记录两组双肺通气20 min(T0)、OLV 20 min (T1)、30 min(T2)、45 min(T3)、60min(T4)时的氧合指标及血流动力学指标.结果 与T0时比较,T1～T4时两组患者PaO2均明显降低,Qs/Qt明显升高(P＜0.01).与T1时比较,T3、T4时U组患者PaO2显著升高,Qs/Qt显著降低(P＜0.05) ;T4时C组患者PaO2明显升高,Qs/Qt明显降低(P＜0.05).与C组比较,T3、T4时U组患者PaO2明显升高,Qs/Qt明显降低(P＜0.05).两组各时点MAP、HR差异无统计学意义.结论 小剂量乌拉地尔可改善OLV期间动脉氧合,减少肺内分流,但对血流动力学无明显影响.     

Beneficial influence of recombinant human erythropoietin therapy on the rate of progression of chronic renal failure in predialysis patients.

BACKGROUND: Partial correction of anaemia with recombinant human erythropoietin (rHuEpo) has been shown to markedly improve the general condition and quality of life of predialysis patients, but the effects of rHuEpo therapy on blood pressure and the rate of progression of chronic renal failure (CRF) are still disputed. In particular, no study evaluated the time duration until the start of maintenance dialysis in treated patients, compared to untreated predialysis patients. METHODS: We retrospectively evaluated the rate of decline of creatinine clearance (Delta Ccr) and the duration of the predialysis period in 20 patients with advanced CRF treated with rHuEpo (Epo+ group), and in 43 patients with a similar degree of CRF but with less marked, asymptomatic anaemia, not requiring rHuEpo therapy (Epo- group). All patients were submitted to identical clinical and laboratory surveillance. All received similar oral supplementation with B(6), B(9), and B(12) vitamins and oral iron supplementation. Maintenance dose of subcutaneous epoetin was 54.3+/-16.5 U/kg/week (median dose 3300 U/week). RESULTS: Initial and final haemoglobin (Hb) levels were 8.8+/-0.7 and 11.3+/-0.9 g/dl in the Epo+ group, vs 10.9+/-1.2 and 9.5+/-0.9 g/dl in the Epo- group. In the Epo+ group, Delta Ccr declined from 0.36+/-0.16 during the preceding 24 months to 0.26+/-0.15 ml/min/ 1.73 m(2)/month after the start of rHuEpo therapy (P<0.05). No significant variation was observed in the Epo- group. Time duration until the start of dialysis was 16.2+/-11.9 in the Epo+ group, compared to 10.6+/-6.1 months in the Epo- group (P<0.01). Slowing of progression was observed in 10 Epo+ patients, whereas no significant variation in Delta Ccr occurred in the other 10. There was no difference in previous Delta Ccr rate, nor in Hb or blood pressure levels while on rHuEpo therapy between the two subgroups. CONCLUSIONS: Our study affords conclusive evidence that rHuEpo therapy did not result in accelerated progression of CRF in any treated predialysis patients, nor deleterious increase in blood pressure, but instead resulted in significant slowing of progression and substantial retardation of maintenance dialysis. Such encouraging results remain to be validated in a large prospective, randomized study.     

舒芬太尼用于全凭静脉麻醉40例研究

目的：探讨舒芬太尼全凭静脉复合麻醉时对听觉诱发电位指数、血流动力学和术后复苏的影响.方法：40例美国标准协会（ASA）Ⅰ～Ⅱ级病人择期行胆囊切除手术,随机分为Ⅰ组（舒芬太尼组）和Ⅱ组（芬太尼组）,记录两组病人麻醉期间各时间点的听觉诱发电位指数（AEPI）值、收缩压、舒张压、心率和SpO2.结果：Ⅱ组插管后1 min、2 min的收缩压较Ⅰ组升高,而插管后1 min的心率较Ⅰ组降低（P＜0.05）;Ⅰ组插管后1 min、2 min和3 min时的AEPI值低于Ⅱ组（P＜0.05）;Ⅰ组拔管后至定向力恢复的时间较Ⅱ组长（P＜0.05）;Ⅰ组丙泊酚的用量较Ⅱ组少（P＜0.05）.结论：等效剂量的舒芬太尼较芬太尼的全凭静脉复合麻醉可以使病人达到更为合适的麻醉深度,并能使血流动力学更加稳定,同时可减少丙泊酚用量.     

Early outcomes of surgery for small bowel obstruction: analysis of risk factors

OBJECTIVES: The study aimed to review the etiologies of patients who underwent surgery for small bowel obstruction (SBO) and to evaluate the risk factors affecting the early postoperative outcomes. MATERIALS AND METHODS: A case series of 430 patients (252 men) with a mean age of 64.5 years, who underwent 437 operations for SBO, were retrospectively reviewed. RESULTS: Peritoneal adhesions and hernia were the most common causes of SBO, contributing 42.3 and 26.8% of all cases, respectively. Strangulation occurred in 27.7% and caused nonviable bowel in 13.0% of obstructing episodes. Old age (age >/= 70 years), female patient, nonadhesive obstruction, and hernia were the independent significant factors associated with bowel strangulation. The 30-day mortality was 6.5%, and the median postoperative hospital stay was 8 days. Old age, the presence of premorbid pulmonary disease, and malignant obstruction were the independent factors associated with operative mortality. The overall complication rate was 35.5%, and old age was the only significant factor associated with postoperative complications. CONCLUSIONS: Surgery for SBO is still associated with significant mortality and morbidity. As old age is significantly associated with an increased incidence of strangulation, operative mortality, and complications, this group of patients should be managed with extra cautions to avoid unfavorable outcome of surgery.     

Ischemia-reperfusion of small liver remnant promotes liver tumor growth and metastases--activation of cell invasion and migration pathways.

Elucidating the mechanism of liver tumor growth and metastasis after hepatic ischemia-reperfusion (I/R) injury of a small liver remnant will lay the foundation for the development of therapeutic strategies to target small liver remnant injury, and will reduce the likelihood of tumor recurrence after major hepatectomy or liver transplantation for liver cancer patients. In the current study, we aimed to investigate the effect of hepatic I/R injury of a small liver remnant on liver tumor development and metastases, and to explore the precise molecular mechanisms. A rat liver tumor model that underwent partial hepatic I/R injury with or without major hepatectomy was investigated. Liver tumor growth and metastases were compared among the groups with different surgical stress. An orthotopic liver tumor nude mice model was used to further confirm the invasiveness of the tumor cells from the above rat liver tumor model. Significant tumor growth and intrahepatic metastasis (5 of 6 vs. 0 of 6, P=0.015), and lung metastasis (5 of 6 vs. 0 of 6, P=0.015) were found in rats undergoing I/R and major hepatectomy compared with the control group, and was accompanied by upregulation of mRNA levels for Cdc42, ROCK (Rho kinase), and vascular endothelial growth factor, as well as activation of hepatic stellate cells. Most of the nude mice implanted with liver tumor from rats under I/R injury and major hepatectomy developed intrahepatic and lung metastases. In conclusion, hepatic I/R injury of a small liver remnant exacerbated liver tumor growth and metastasis by marked activation of cell adhesion, invasion, and angiogenesis pathways.     

Tumor Treated by Endoscopy

Background

This study was conducted to examine the clinical usefulness and efficacy of endoscopic curettage on benign bone tumor.

Methods

Thirty-two patients (20 men and 12 women) with benign bone tumor were included in the study. The patients were aged between five and 76 years; the mean follow-up period was 27.05 months (range, 9.6 to 39.9 months). The primary sites include simple bone cyst (9 cases), fibrous dysplasia (6 cases), enchondroma (5 cases), non-ossifying fibroma (4 cases), bone infarct (3 cases), aneurysmal bone cyst (1 case), chondroblastoma (1 case), osteoblastoma (1 case), intraosseous lipoma (1 case), and Brodie abscess (1 case). A plain radiography was performed to assess the radiological recovery. Radiological outcomes, including local recurrence and bone union, were evaluated as excellent, good, poor, and recurred.

Results

In our series, there were 27 cases (84.4%) of good or better outcomes, six cases (18.8%) of complications (4 local recurrence, 1 wound infection, and 1 pathologic fracture).

Conclusions

Our results showed that endoscopic curettage and bone graft had a lower rate of recurrence and a higher cure rate in cases of benign bone tumor. It can, therefore, be concluded that endoscopic curettage and bone graft might be good treatment modalities for benign bone tumors.     

Is endemic political corruption hampering provision of ART and PMTCT in developing countries?

Introduction

Leadership is a key factor in the success of HIV prevention and treatment. Positive HIV-related outcomes are also affected by funding levels for HIV, health sector resources, disease burden and the socio-economic environment. Leadership on HIV as well as these other factors are affected by the quality of political governance of the country, which may be an overarching factor that influences the making of effective responses to the HIV epidemic.

Aim

The aim of the study was to investigate the association between quality of political governance, on one hand, and coverage of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT), on the other, in low- to middle-income countries.

Methods

This investigation was carried out through a global review, online data sourcing and statistical analyses. We collected data on health burden and resources, the socio-economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. Outcome variables were coverage of ART (from 2004) and PMTCT (from 2007) to 2009 as a percentage of persons needing it. Potential predictors of treatment coverage were fitted with a baseline multilevel model for univariable and multivariable analyses.

Results

Countries with higher levels of political voice and accountability, more political stability and better control of corruption have higher levels of ART coverage but not PMTCT coverage. Control of corruption (in standard deviation units) had a strong association with ART (AOR=1.82, p=0.002) and PMTCT (AOR=1.97, p=0.01) coverage. Indicators of economic development were not significant when control of corruption was included in the multivariable regression model. Many countries in all income groups had high ART but not PMTCT coverage (e.g. Mexico, Brazil and Romania in the upper-middle-income group; Papua New Guinea and Philippines in the lower-middle-income group; and Cambodia, Laos and Comoros in the low-income group). Very few low-income countries (notably, Haiti and Kenya) had high PMTCT coverage.

Conclusions

Our research found a significant relationship between quality of political governance and treatment coverage. Measures and policies for improving the quality of political governance should be considered as a part of HIV programme implementation to more effectively improve the welfare of people living with HIV, particularly mothers living with HIV and their babies.     

A Body Shape Index Has a Good Correlation with Postoperative Complications in Gastric Cancer Surgery

Background

The relationship between obesity and surgical complications has been controversial. A Body Shape Index (ABSI) is a newly developed anthropometric index based on waist circumference adjusted for height and weight. The aim of this study was to investigate the relationship between ABSI and surgical complications.

Methods

From November 2001 to September 2012, 4,813 patients underwent curative resection for gastric cancer. ABSI was defined as waist circumference divided by (BMI^2/3height^1/2). Data of clinicopathologic characteristics and morbidity were collected by retrospective review. Binary logistic regression was used for multivariable analyses to determine whether ABSI was independently associated with postoperative complications.

Results

The incidence of overall surgical complications was 13.4 %, and the most common complication was ileus (2.8 %). In the multivariable analysis, ABSI was an independent factor for overall complications [odds ratio (OR), 1.22; 95 % confidence interval (CI) 1.01–1.48; P = 0.041). However, BMI showed no statistical significance (OR, 1.03; 95 % CI 1.00–1.06; P = 0.063). In the subgroup analyses, ABSI was significantly associated with overall complications regarding open gastrectomy (OR, 1.26; 95 % CI 1.01–1.57; P = 0.039). Regarding laparoscopy-assisted gastrectomy, ABSI had no significant effect on overall complications (P = 0.844).

Conclusions

ABSI shows good correlation with surgical complications in patients with gastric cancer. Further studies are needed for the various clinical roles of ABSI, and the results could be helpful to determine the effect of abdominal obesity on gastric cancer surgery and the clinical usefulness of ABSI.