Extensive hepatectomy can achieve a higher chance of radical resection of lesions in the hepatobiliary system, but the risk of fatal complications of severe liver failure after surgery also increases accordingly. Therefore, enhancing the liver’s regenerative capacity has always been a hot topic in clinical research. Portal vein blood supply is of great significance for maintaining the normal function of the liver and promoting the repair and proliferation of damaged liver tissue. After selectively altering the blood flow distribution in the portal vein, atrophy or proliferation will occur in different liver lobes. The discovery of the important physiological phenomenon of liver regeneration induced by deportalized blood flow of portal vein has made it possible to promote the volume growth and functional enhancement of the residual liver lobes before hepatectomy, and various technical schemes have been applied and developed in clinical practice. The interim research results show that the portal vein embolization technique is mature, has less trauma, but the induction speed is relatively slow. Portal vein combined with hepatic vein embolization has better induction efficacy and does not increase embolism-related complications, and has a wider range of applications. The induction ability of associating liver partition and portal vein ligation for staged hepatectomy is significant, but the surgical trauma is large, and there are higher requirements for perioperative management. There is a clear correlation between high surgical volume centers and technical improvements and a significant reduction in complications. Resection and partial liver transplantation with delayed total hepatectomy not only break through the bottlenecks of safety and ethical requirements for living donor liver transplantation in adults, but also innovate and enrich the second-stage extensive hepatectomy schemes. However, their technical standards and application scope still need more high-quality research evidence to support them.
Lung cancer is a complex disease with its own challenges, and is considered to be one of the most common causes of cancer death worldwide. The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has exacerbated these challenges. The aim of this review is to explore the impact of the COVID-19 pandemic on the screening, diagnosis and treatment of lung cancer. We hope to provide some experience and help for the whole process management of lung cancer patients.
ObjectiveTo compare the anesthetic potency and influence on maternal hemodynamics among spinal anesthesia (SA), epidural anesthesia (EA) and combined spinal epidural anesthesia (CSEA) for women undergoing cesarean sections. MethodsA total of 180 singleton term nulliparous pregnancies of American Sociaty of Anethesiologists physical status Ⅰor Ⅱ for cesarean sections in Guangyuan Central Hospital from January to December 2012 were allocated into three groups using the method of random number table. Patients in group SA received SA (n=60), group EA underwent EA (n=60) and patients in group CSEA accepted CSEA (n=60). Patients wderwent punere all placed in left lateral position. Group EA patients unctures at the L1-2 interspace and the volume of carbonated lidocaine used initially was 12-15 mL. Group SA and CSEA accepted the anesthesia at either L2-3 or L3-4 interspace. The volume for group SA was 0.75% bupivacaine 1.2 mL with 10% glucose solution 1 mL, and for group CSEA was 0.5% bupivacaine 1.4 mL with 10% glucose solution 0.8 mL. A catheter was inserted into the epidural space for 3-4 cm after spinal needle exit so as to add additional epidural medication according to the block level and the level of anesthesia subsidence. The values of the basis of blood pressure and heart rate, the lowest blood pressure and heart rate, umbilical venous blood gas, start effect and induction time of anesthesia and the highest block level of anesthesia were record. ResultsThere were statistically significant differences in terms of start effect time of anesthesia among the three groups (F=24.642, P<0.001). The start effect time of anesthesia in group SA and CSEA was significantly shorter than that in group EA (t=8.076, 7.996; P<0.05). The induction time of anesthesia in group SA was significantly shorter than those in group EA and CSEA (P<0.05). The lowest blood pressure and heart rate in group SA and CSEA were significantly lower than the values of basis (P<0.05). The lowest blood pressure and heart rate in group SA was significantly lower than that in group EA (P<0.05). The incidence of hypotension and bradycardia in group SA and CSEA was significantly higher than that in group EA (P<0.05). The block level of anesthesia in the three groups were at thoracic 8.12±1.22, 8.36±1.88 and 8.52±1.92 respectively, and there was no significant difference among the three groups (F=0.081, P=0.923). ConclusionEA and CSEA surpass SA in the choice of neuraxial anesthesia for cesarean sections, and 1.73% carbonated lidocaine for EA can improve anesthetic potency and better maintain relatively stable hemodynamic indexes.
Objective To determine the effect of closed tracheal suction system versus open tracheal suction system on the rate of ventilator-associated pneumonia in adults. Methods We searched The Cochrane Library (Issue 1, 2007), PubMed (1966 to 2006) and CBM (1980 to 2007), and also hand searched relevant journals. Randomized controlled trials involving closed tracheal suction system versus open tracheal suction system for ventilator-associated pneumonia in adults were included. Data were extracted and the quality of trials was critical assessed by two reviewers independently. The Cochrane Collaboration’s RevMan 4.2.8 software was used for data analyses. Result Five randomized controlled trials involving 739 patients were included. Results of meta-analyses showed that compared to open tracheal suction system, closed tracheal suction system did not increase the rate of ventilator-associated pneumonia (RR 0.83, 95%CI 0.50 to 1.37) or case fatality (RR 1.05, 95%CI 0.85 to 1.31). No significant differences were observed between open tracheal suction system and closed tracheal suction system in the total number of bacteria (RR 0.83, 95%CI 0.50 to 1.37), the number of SPP colony (RR 2.87, 95%CI 0.94 to 8.74) and the number of PSE colony (RR 1.46, 95%CI 0.76 to 2.77). There was no significant difference between the two groups in the duration of ventilation and length of hospital stay. Conclusion Open or closed tracheal suction systems have similar effects on the rate of ventilator-associated pneumonia, case fatality, the number of SPP and PSE colonies, duration of ventilation and length of hospital stay. However, due to the differences in interventions and statistical power among studies included in this systematic review, further studies are needed to determine the effect of closed or open tracheal suction systems on these outcomes.
ObjectiveTo explore the effect of metabolic syndrome (MS) on postoperative pulmonary infection in patients with colorectal cancer (CRC) and to construct a risk prediction model for postoperative pulmonary infection in CRC patients. MethodsRetrospective collection of clinical data from 291 CRC patients who underwent surgical treatment at Department of General Surgery, Suzhou Ninth People’s Hospital in the period of January 2020 to August 2024. To explore the risk factors of postoperative pulmonary infection in patients with CRC and to establish a nomogram model. ResultsAmong the 291 CRC patients enrolled, there were 58 MS patients (19.93%) and 233 non-MS patients (80.07%). Compared with patients without MS, CRC patients with MS had longer surgery time (P<0.001) and higher incidence of postoperative pulmonary infection (P<0.001). The results of multiple logistic regression analysis showed that smoking history [OR=2.184, 95%CI (1.097, 4.345), P=0.026], body mass index (BMI)≥25 kg/m2 [OR=2.662, 95%CI (1.241, 5.703), P=0.012], MS [OR=2.770, 95%CI (1.415, 5.425), P=0.003], increased surgical time [OR=4.039, 95%CI (1.774, 9.197), P<0.001] and increased intraoperative bleeding [OR=2.398, 95%CI (1.246, 4.618), P=0.009] were all risk factors for postoperative pulmonary infection in CRC patients. Based on these risk factors, a nomogram model was constructed. The area under the curve (AUC) was 0.845 [95%CI (0.769, 0.906)], and the sensitivity and specificity were 84.2% and 87.5% respectively. The internal verification of Bootstrap test showed that the simulated curve and the actual curve had good consistency. The clinical decision curve analysis showed that when the threshold probability was in the range of 8%–84%, the net benefit of the model for patient diagnosis was higher. ConclusionsMS increases the risk of postoperative pulmonary infection in CRC patients. At the same time, smoking history, BMI≥25 kg/m2, long operation time, and more intraoperative blood loss are also risk factors for postoperative pulmonary infection in patients with CRC. Building a model based on this can effectively evaluate the risk of postoperative pulmonary infection in CRC patients.
Esophageal carcinoma is a kind of common malignant tumor in the digestive tract. Although a lot of basic researches and clinical trials have been carried out all over the world, neither the diagnostic level nor the therapeutic effects have been obviously improved. The 5-year survival rate of esophageal cancer patient is still lower than that of other malignant tumors. Up to now, some frontier researches consider that the reason of the esophageal carcinoma being difficult to cure is related to the stem cells in it. Elimination or suppression of these stem cells may bring new hope for the treatment of esophageal cancer. This article generally introduces the specific markers, separation and indentification methods about the esophageal cancer stem cell. The targeted therapy is also mentioned.
目的:探讨鼻(面)罩无创双水平气道正压通气(BiPAP)在慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的治疗作用。方法:入选病例60例,分为常规治疗组28例,采用常规治疗;呼吸机治疗组32例,在常规资料基础上加用BiPAP无创呼吸机治疗,两组患者心率,呼吸频率,血气分析比较。结果:呼吸机治疗组患者心率,呼吸频率,血气分析的改善优于常规治疗组,差异有统计学意义(Plt; 0.05)。结论:无创双水平气道正压机械通气辅助治疗COPD合并Ⅱ型呼吸衰竭具有肯定的疗效,能更快地缓解患者的临床症状;提高PaO2,SaO2和降低PaCO2;能更好地促进病情的恢复,减少住院时间。