Objective To explore the clinical value of Wells score combined with thromboelastography (TEG) in rapid prediction of pulmonary embolism (PE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 130 AECOPD patients admitted to the Department of Respiratory and Critical Care Medicine of Guangxi University of Science and Technology from January 2022 to March 2023 were selected as the study subjects. According to results of digital subtraction angiography (DSA) of the pulmonary artery, the patients were divided into a PE group (n=37) and a non-PE group (n=93). Both groups underwent Wells score analysis combined with TEG. Thromboelastographic parameters were comparing between the two groups, including Wells score, reaction time (R time), reaction time (K time), coagulation index (CI), and maximum amplitude (MA). The diagnostic value of different prediction models to diagnose AECOPD with PE was compared, including Wells score, thromboelogram and Wells score combined with TEG. Results The Wells score of the patients in the PE group was significantly higher than that in the non-PE group, and R time of the patients in the PE group was significantly lower than that in the non-PE group. The K time, CI, MA and other parameter levels of the patients in the PE group were significantly higher than those in the non-PE group (all P<0.05). The sensitivity, specificity, and area under ROC curve of the combination of Wells score and TEG prediction model in diagnosing AECOPD complicated with PE were greater than those of the Wells score alone prediction model (P<0.05). Conclusion The combination of Wells score and TEG has significant clinical value in quickly predicting AECOPD complicated with PE, and is worthy of clinical application and promotion.
ObjectiveTo compare the effects of piriformis muscle release versus preservation in total hip arthroplasty (THA) via supercapsular percutaneously-assisted total hip (SuperPATH) approach on muscle injury. MethodsForty-nine patients undergoing initial THA via SuperPATH approach were randomly divided into two groups, with 24 patients in trial group and 25 patients in control group. The trial group received piriformis muscle release intraoperatively, whereas the control group underwent muscle preservation. There was no significant difference in baseline data such as gender, age, body mass index, disease type, American Society of Anesthesiologists (ASA) grading, comorbidities, and preoperative muscle infiltration, muscle atrophy, muscle injury serological indicators, Harris score, etc. (P>0.05). The incision length, operation time, intraoperative blood loss, total blood loss, hospital stay, preoperative and postoperative 1-day muscle injury serological indicators [including creatine kinase (CK) and lactic dehydrogenase (LDH)], and incidence of complications between two groups were recorded. Harris score was used to evaluate the recovery of hip joint function. MRI was used to evaluate the extent of hip muscle injuries (gluteus medius, gluteus medius, piriformis, adductor, quadriceps), including tendon integrity, degree of muscle fat infiltration, and degree of muscle atrophy preoperative and 1 year postoperatively. ResultsThe operation time, intraoperative blood loss, and total blood loss in the trial group were significantly shorter than those in the control group (P<0.05). There was no significant difference in the incision length and length of hospital stay between the two groups (P>0.05). Both groups showed a significant increase in serum CK and LDH levels on postoperative day 1 compared to preoperative levels (P<0.05), but there was no significant difference between the two groups (P>0.05). All patients were followed up, the follow-up time for the trial group and the control group was (14.8±2.8) and (15.1±3.0) months, respectively, with no significant difference (t=−0.400, P=0.691). Incisions healed by first intention in both groups, with 1 case in the trial group and 2 cases in the control group experiencing venous thrombosis in the calf muscle space. There was no complication such as deep vein thrombosis, pulmonary embolism, hip dislocation, prosthesis loosening, or periprosthetic infection in the lower limbs. There was no significant difference in the incidence of complications between the two groups (P>0.05). At 1 year after operation, both groups of patients showed a significant increase in Harris scores compared to preoperative levels (P<0.05), but there was no significant difference between the two groups (P>0.05). Compared with preoperative results, both groups showed significant fat infiltration in the piriformis and obturator muscles at 1 year after operation (P<0.05), while there was no significant fat infiltration in the gluteus medius, gluteus medius, and quadratus femoris muscles (P>0.05). At 1 year after operation, except for the higher incidence of piriformis muscle fat infiltration in the control group compared to the experimental group (P<0.05), there was no significant difference in the incidence of other muscle infiltrations between the two groups (P>0.05). At 1 year after operation, both groups of piriformis and obturator muscles showed significant muscle atrophy compared to preoperative levels (P<0.05). The gluteus medius and gluteus medius showed mild atrophy compared to preoperative levels, while the maximum transverse diameter of the quadriceps muscle slightly increased, but the differences were not significant (P>0.05). There was no significant difference in the maximum cross-sectional diameter or cross-sectional area changes of each muscle between the two groups (P>0.05). At 1 year after operation, the continuity of the gluteus medius and quadratus femoris muscles in both groups was intact. Both groups had some patients with incomplete continuity of the piriformis muscle, adductor muscle, and gluteus maximus muscle, but the difference was not significant (P>0.05). ConclusionThe SuperPATH approach THA may cause injury to the piriformis, gluteus minimus, and obturator internus. The piriformis muscle release does not increase muscle injury, but it can shorten the operation time and reduce bleeding.
ObjectiveTo evaluate the effect of disinfection measures in the isolation ward of ICU in severe patients infected with the Omilkerong variant of the new coronavirus, and to optimize the infection control measures. MethodsReferring to the patient's epidemiological and nucleic acid sample data, nucleic acid sampling was performed on the isolated ward environment by surface sampling method, and the nucleic acid Ct value of virus was detected by parallel fluorescence PCR method. The aerosol was collected by a wet-wall cyclone sampler, and the nucleic acid Ct value of the virus was detected by parallel fluorescence PCR. ResultsBefore daily disinfection, SARS-CoV-2 positive samples were found on the surface of the patient's ward and air sampling after the tracheoscopic tracheostomy. No positive samples of SARS-CoV-2 were found on the surface of articles and air in the patient's ward after daily disinfection. ConclusionThe daily disinfection measures of the hospital can achieve the effect of SARS-CoV-2 disinfection, which suggests that the surface of the articles in the ward after invasive operations such as tracheostomy and tracheoscopy, especially within 2 meters of the tracheostomy and the tracheostomy, is the key part of disinfection, which needs to be paid attention to.