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1.
Hsien-Chi Liao Jen-Hao Chuang Hsao-Hsun Hsu Ke-Cheng Chen Jin-Shing Chen 《Surgical endoscopy》2020,34(4):1641-1647
Thoracic empyema in uremic patients on maintenance hemodialysis is a challenging situation. The clinical characteristics are rarely reported, and the surgical outcomes remain unclear. We report our experience with video-assisted thoracoscopic surgery in these patients during 10-year period of time. Between 2005 and 2015, we retrospectively reviewed the clinical characteristics, bacteriological studies, and thoracoscopic surgical results of 23 empyema patients undergoing maintenance hemodialysis. The mean patient age was 67.1 ± 12.9 years. All patients had additional preexisting systemic diseases. The mean duration of hemodialysis was 34.7 ± 25.8 months. The infections causing empyema were pneumonia in 11 (47.8%), blood stream infection in 8 (34.8%), and uremic pleuritis in 4 (17.4%). Among the 22 identified microorganisms, the most common pathogen was methicillin-resistant Staphylococcus aureus (31.8%). After thoracoscopic surgery, 8 patients (34.8%) required additional procedures for complications, including 2 patients who required repeated thoracoscopy for hemothorax and 6 (26.1%) patients who required open drainage for residual empyema. The mean hospital stay was 62.4 days, and 6 patients (26.1%) died in the hospital. Univariate and multivariate analyses revealed that maintenance hemodialysis longer than 5 years was a significant factor associated with in-hospital mortality (odds ratio: 14.8, 95% confidence interval 1.5–151.6; p < 0.0001). While surgical management of thoracic empyema in uremic patients undergoing maintenance hemodialysis is associated with high rates of complication and mortality, thoracoscopic surgery is feasible, especially for patients undergoing hemodialysis for less than 5 years. 相似文献
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Yu Fan Xiaoling Liao Yuesong Pan Kehui Dong Yilong Wang Yongjun Wang 《Journal of stroke and cerebrovascular diseases》2019,28(1):220-226
Background
The intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) therapy is safe and efficient during the treatment of acute ischemic stroke. Nonetheless, the different outcomes among various stroke subgroups have limited data with regard to the safety and efficacy of cryptogenic stroke (CS). The present study compared the safety and efficacy when IVT with rt-PA was used for the treatment of CS and the other stroke subtypes.Methods
This study classified the IVT with rt-PA patients within 4.5 hours after stroke onset, based on the trial of ORG 10172 in acute stroke treatment criteria in terms of diagnostic evaluation. The data were obtained from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China database, a large multicenter prospective registry. A multivariable logistic regression model was employed to compare the differences between the subtypes in symptomatic intracerebral hemorrhage (sICH) within 7 days and studied the mortality and the outcome during 90 days.Results
In total, 1118 patients were recruited; of these, 131 (11.7%) suffered from CS and 987 (88.3%) with the other etiology. In the CS group, patients were younger than those in the other etiology groups (P < .001). Moreover, it had a lower prevalence of previous stroke (P?=?.0117), receiving antiplatelet drug in 24 hours prior to thrombolysis (P?=?.0017), and functional independence (mRS > 1 before stroke, P?=?.003). The CS group had lower blood pressure (systolic blood pressure P?=?.0001; diastolic blood pressure; P?=?.0212) before thrombolysis, atrial fibrillation (P < .001), and diabetes mellitus (P?=?.0005). Transient ischemic attack, hypertension, hyperlipidemia, blood glucose, receiving anticoagulants in 24 hours prior to thrombolysis, and standard dosage of rt-PA were equally distributed in both groups. After the adjustment of confounders between the CS and the other subgroups, no obvious differences were observed in sICH rate and mortality (P > .05) The CS patients exhibited excellent recovery (mRS, 0-1; 63.78%) and functional independence (mRS, 0-2; 74.8%) than the large artery atherosclerosis patients.Conclusions
IVT with rt-PA is a safe and effective method for the treatment of CS patients. 相似文献5.
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目的探讨专科护士-社区护士-个体-家庭四方联动防跌护理模式在社区跌倒高危老年人中的应用与效果。方法选取深圳市龙岗区的2个社区,随机分为观察组和对照组,从两个社区登记建档的跌倒高风险老年居民中分别随机抽选45名进行干预。观察组采用"专科护士-社区护士-个体-家庭"四方联动推进的综合干预方案。对照组接受社区防跌倒常规护理。于干预前及干预后12个月使用修订版社区老年人跌倒危险评估量表、步态和平衡测试量表对两组老年人进行评测,记录两组1年内跌倒发生例次。结果干预期间跌倒发生情况:观察组1人次,对照组6人次。观察组步态和平衡测试得分提高,跌倒危险评估表得分降低,与对照组比较,差异有统计学意义(均P0.01)。结论四方联动的综合干预方案应用于社区居家老年人,能有效降低老年人跌倒风险,提升其防跌能力,对预防社区老年人跌倒的发生有积极作用。 相似文献
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Lester Liao 《Medical teacher》2020,42(5):585-587
AbstractEntitlement is a problem in medical education that has received relatively little attention. First, it is felt by educators, who often feel pressured to conform curricula and evaluations to satisfy learner demands and administrative pressures lest their careers are penalized. Second, entitlement affects the medical system, as entitled physicians are less empathetic and focus more on personal goods rather than patient needs. This shifts the humanistic basis for medicine. Thirdly, entitlement is problematic for learners, as constant accommodations ironically undermine self-reliance and adaptability. Constantly meeting these demands can diminish gratitude and overall happiness. To address this issue, learners must acknowledge the problem and seek remedies to it themselves, as top-down interventions will likely be rebuffed. Rather than focusing solely on the learning environment, solutions should also empower learners to engage their environment in effective and productive ways. This should include correcting cognitive distortions that lead learners to expect administrative interventions in all circumstances perceived as harmful. Other solutions include practicing gratitude and developing work friendships. While certainly not all learners are entitled and some environmental amendments should be made, learners and educators must realize that entitlement is shaping medical culture and collectively take steps to mitigate its negative effects. 相似文献
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Ye Gao Lei Xin Yu-Xin Wang Yuan-Hang Dong Zhuan Liao 《Scandinavian journal of gastroenterology》2020,55(1):105-113
AbstractBackground and aim: Capsule retention is the most common adverse event associated with video capsule endoscopy. The use of double-balloon enteroscopy-assisted capsule endoscope retrieval has been increasingly reported in recent years. However, evidence is limited regarding its success rate, associated factors, and subsequent clinical outcomes.Methods: A systematic review of relevant studies published before January 2019 was performed. Successful retrieval rate and associated factors, rate of endoscopic balloon dilation, and outcomes after double-balloon enteroscopy were summarized and pooled.Results: Within 154 associated original articles, 12 including 150 cases of capsule retrieval by double-balloon enteroscopy were included. The estimated pooled successful retrieval rate was 86.5% (95% confidence interval, 75.6–95.1%). Anterograde approach and capsules retained in the jejunum or trapped by malignant strictures were associated with a higher successful retrieval rate than the retrograde approach (62/83 [74.7%] vs. 10/38 [26.3%], p?<?.001) and capsules retained in the ileum (41/41 [100.0%] vs. 43/58 [74.1%], p?<?.001) or trapped by benign strictures (21/21 [100.0%] vs. 65/83 [78.3%], p?=?.043). Endoscopic balloon dilation was performed in 38.8% (95% confidence interval, 22.3–56.3%) of patients with benign strictures. Two perforations (1.3%) were reported as severe adverse events after double-balloon enteroscopy. A significantly lower surgery rate was found among cases with successful video capsule removal compared with unsuccessful cases (7.2% vs. 38.5%, p?=?.002).Conclusions: Double-balloon enteroscopy is feasible and safe for removing retained video capsule endoscopes, and its use could decrease the need for surgery in patients with benign strictures and facilitate subsequent surgery in patients with malignant strictures. 相似文献
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