Objective To evaluate the effect of early clinical interference strategies on preventing the conversion of acute pancreatitis to the severe form and aggravation of severe acute pancreatitis (SAP). Methods The patients with acute pancreatitis admitted to this hospital were divided into two therapeutic phases by different therapeutic methods from January 2001 to December 2008. Patients in the first phase (from January 2001 to December 2004) were treated by the routine management, and the second phase (from January 2005 to December 2008) by the routine management combined with early clinical interference strategies. Then, the ratio of conversion from acute pancreatitis to SAP and prognosis of SAP between two phases were compared. Results Compared with the first phase, the rate of aggravation of acute pancreatitis was significantly decreased in the second phase (4.48% vs. 21.18%), the average healing time of SAP, the incidences of systemic and local complications and the mortality of pancreatitis were reduced (P＜0.05). When early clinical interference strategies were performed, some adverse reaction and complications occurred in 35 cases, but without severe consequence. Conclusion Early clinical interference strategies may serve as a beneficial strategy on preventing the progression of mild acute pancreatitis to the severe form or halting the aggravation of acute pancreatitis.
ObjectiveTo explore the optimal preoperative management strategy in patients with acute type A aortic dissection and pericardial tamponade.MethodsA total of 197 patients with acute type A aortic dissection were admitted to the Cardiovascular Center at the Second Affiliated Hospital of Nanjing Medical University from 2017 to 2019, among whom 26 patients suffered from cardiac tamponade, including 20 males and 6 females with an average age of 59.27±10.76 years. The clinical data of the patients were analyzed.ResultsAll patients underwent surgical repair of the aorta. The median cardiopulmonary bypass time and aortic cross clamping time were 174.5 min and 121.5 min, respectively. Postoperative complications included kidney failure in 3 patients, respiratory failure in 2 patients and disturbance of consciousness in 3 patients. Postoperative death occurred in 5 (19.2%) patients. The other 21 patients were successfully followed up for 2 years, during which 1 patient died with a survival rate of 95.2%, and no re-intervention was indicated.ConclusionAdequate preoperative management is crucial in patients with acute type A aortic dissection complicated with cardiac tamponade. A cardiac surgery team with round-the-clock availability, an integrated cardiac surgery ward and a rational algorithm that can shorten the time from disease onset to surgery treatment are the keys to improve survival rate.
Dysphagia is a common non-motor symptom in Parkinson’s disease (PD), with a high incidence and insidious progression. It can lead to complications such as dehydration, malnutrition, aspiration pneumonia, and even death, seriously affecting the quality of life and prognosis of patients. Therefore, early screening, assessment, and intervention are crucial for improving the quality of life and prognosis of PD patients with dysphagia. This article mainly reviews the risk factors and management strategies of dysphagia in PD, with the aim of providing a reference for healthcare professionals to conduct subsequent evaluations and develop targeted interventions.
Objective To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C2 segment. Methods The literature about the surgery for cervical OPLL involving C2 segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized. Results For cervical OPLL involving the C2 segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification. Conclusion OPLL involving the C2 segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C2 segment.
Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.
In order to understand the latest progress of health decision support system (HDSS) construction, grasp the law of HDSS development and adopt the international advanced experience, this paper took Australia for example, presented a comparative analysis on the construction practices, including the contents, features and system functions of national construction guidelines for HDSS in different periods, and showed the integral development level of Australia HDSS was still in the exploratory stage, and its construction goal, function orientation and construction mechanism got improved gradually with the deep development of public health information. Additionally, to assure the accuracy and safety of HDSS function, Australia has been laying stress on the standard specification construction and system function authentication.
Thoracic trauma has the characteristics of complexity, specificity, urgency and severity. Therefore, the treatment is particularly important. Thoracic Traumatology Group, Trauma Medicine Branch of Zhejiang Medical Association organized the writing of the thoracic trauma and further optimization consensus of Zhejiang thoracic surgery industry Treatment and diagnosis of rib and sternum trauma: A consensus statement by Zhejiang Association for Thoracic Surgery (version 2021), compiled the popular science book Emergency Treatment and Risk Avoidance Strategy of Thoracic Trauma and Illustration of Real Scene Treatment of Trauma, actively prepared to build the trauma database of Zhejiang Province, and participated in the construction of trauma group in the Yangtze River Delta. Although Zhejiang Province has carried out many related works in the diagnosis and treatment of chest trauma, it is still inconsistent with the development requirements of the times. Standardization of chest trauma treatment, popularization of relevant knowledge, management of trauma big data, grass-roots radiation promotion tour and further optimization of industry consensus are the requirements and objectives of this era.