Objective To develop an evaluation tool for the screening of high risk population for oral complications in critically ill patients, which can be performed accurately and scientifically. Methods Basing on the related foreign oral assessment scale, combined with the method of brainstorming, expert consultation, method of clinical status and so on, the item pool of the assessment scale was determined. Five nursing experts and two oral experts assessed the content validity and 50 ICU nurses were tested. Then, the screening accuracy of the assessment scale was proved by application in 100 critically ill patients selected randomly. Results The Cronbach’s a coefficient of final version of the High Risk Assessment Scale for Oral Complications in Critically Ill Patients (including seven parts contents of oral health assessment and oral pH value test) was 0.815, the content validity index (Sr-CVI/Ave) was 0.932. The results of 50 nurses to the 91.2% assessment items of the assessment scale were very important and important. For screening related indicators of oral complications in high-risk patients, the sensitivity of the assessment scale was 97.53%, the specificity was 94.11%, the positive predictive value was 98.75%, the negative predictive value was 88.89%, and the crude agreement was 95%. Conclusion There are good reliability, validity and a high accuracy of screening test in the High Risk Assessment Scale for Oral Complications in Critically Ill Patients. It can be used for screening patients at high risk for oral complications in critically ill patients, and help clinical nurses to complete the oral health status of the critically ill patients quickly.
Objective To observe and analyze the risk factors of secondary intraocular hypertension in diabetic macular edema (DME) patients after treatment with dexamethasone vitreous cavity implant (DEX). MethodsA retrospective observational study. A total of 352 patients with type 2 diabetes mellitus (T2DM) secondary macular edema diagnosed by ophthalmic examination and treated with DEX in Department of Ophthalmology of Harbin 242 Hospital from January 2016 to March 2022 were included in the study. Among them, 221 were males and 131 were females, with the mean age of (55.56±8.09) years. There were 194 patients with disseminated macular edema, 158 patients with cystoid macular edema. All patients underwent vitreous cavity implantation of DEX. Intraocular pressure (IOP) was measured once a month for 3 months after treatment, with IOP over than 25 mm Hg (1 mm Hg=0.133 kPa) or higher than 10 mm Hg from baseline as secondary intraocular hypertension. The relevant clinical data were collected, and the risk factors of secondary intraocular hypertension in DME patients after DEX treatment were analyzed by binary logistic regression. ResultsAmong 352 patients, 116 patients (32.95%, 116/352) were in the intraocular hypertension. Among them, 29 patients (25.00%, 29/116), 69 patients (59.48%, 69/116) and 18 patients (15.52%, 18/116) occurred intraocular hypertension at 1, 2 and 3 months after treatment, respectively. Compared with the normal IOP group, the IOP in the intraocular hypertension group increased significantly at 1, 2 and 3 months after treatment, with statistical significance (t=10.771, 21.116, 13.761; P＜0.001). Compared with normal IOP group, the patients in the intraocular hypertension group had younger age (t=6.967), longer duration of diabetes (t=5.950), longer axial length (AL) (t=14.989), higher proportion of DME grade 3 (Z=6.284), higher proportion of DEX implantation in pars plana (χ2=23.275), and higher HbA1c level (t=10.764), the differences were statistically significant (P＜0.05). Logistic regression analysis showed that longer AL [odds ratio (OR)=1.428, 95% confidence interval (CI) 1.054-1.934], DEX implantation in pars plana (OR=1.358, 95%CI 1.063-1.735), and higher HbA1c (OR=1.702, 95%CI 1.225-2.366) were the risk factors for secondary intraocular hypertension in DME patients after DEX treatment (P＜0.05), older age was a protective factor (OR=0.548, 95%CI 0.380-0.789, P＜0.05). ConclusionsLong AL, DEX implantation in pars plana and high HbA1c are the risk factors for secondary intraocular hypertension after DEX treatment in DME patients, older age is a protective factor.
ObjectiveTo investigate the effect of multi-sided foramen ultrafine drainage tube with metal support on the formation of thoracic residual cavity after uniportal video-assisted thoracoscopic (VATS) upper lobectomy. MethodsThe clinical data of the patients who underwent uniportal VATS upper lobectomy for lung cancer in the Department of Thoracic Surgery of the First Hospital of Lanzhou University from January 2021 to April 2022 were retrospectively analyzed. According to the type of ultrafine drainage tube used in the surgery, the patients were divided into a test group (using metal-supported multi-sided foramen ultrafine drainage tube) and a control group (using ordinary 12F ultrafine drainage tube). The incidence of postoperative thoracic residual cavity and operation-related data were compared between the two groups. ResultsA total of 200 patients were enrolled, including 126 males and 74 females, with a mean age of 57.52 years. There were 90 patients in the test group, and 110 patients in the control group. The incidence of postoperative thoracic residual cavity in the test group was lower than that in the control group (P=0.045). The differences in the postoperative bedtime, postoperative visual analogue scale, postoperative analgesic pump using time, postoperative hospitalization time, times of postoperative thoracentration and drainage, postoperative drainage time and hospitalization cost between the two groups were statistically significant (P<0.05). The incidences of postoperative lung infection, pleural effusion and atelectasis complications were lower in the test group than those in the control group (P<0.05). The differences in the preoperative anesthesia time, operation time, intraoperative bleeding and postoperative lung leakage were not statistically significant (P>0.05). ConclusionThe use of multi-sided foramen ultrafine drainage tube with metal support can reduce the incidence of thoracic residual cavity after uniportal VATS upper lobectomy, and can reduce pain and economical burdens and the incidence of operation-related complications, accelerating the recovery of patients after surgery. The application of multi-sided foramen ultrafine drainage tube with metal support in uniportal VATS upper lobectomy can be widely used in the clinic.
Objective To summarize experience and efficacy of multidisciplinary treatment for severe intra-abdominal infection. Methods The clinical data of 17 patients with severe intra-abdominal infection underwent multidisciplinary treatment were analyzed retrospectively. There were 5 cases of severe acute pancreatitis, 4 cases of postoperative biliary fistula, 2 cases of intestinal fistula, 2 cases of pancreatic trauma, 1 case after resection for intestinal necrosis, 1 case of abdominal trauma, 1 case after operation for liver abscess, 1 case of unexplained severe intra-abdominal infection. The experiences of multidisciplinary treatment including the intensive care unit (ICU), surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on were summarized. Results After multidisciplinary treatment, 13 patients were cured, of which 4 patients treated by non-open operation. Three patients died, including 1 patient died of infectious shock, 1 patient died of pancreatic bed bleeding, 1 patient died of multiple organ failure. There was 1 case of automatic discharge. Conclusions Multidisciplinary treatment including ICU, surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on has an exact clinical curative effect in patients with severe intra-abdominal infection. Concept of damage control should be followed by surgical intervention. Abdominal cavity puncture and drainage has some advantages of small trauma and good clinical effect, which is suitable for infection control of patients with severe intra-abdominal infection, it could provide surgical condition and opportunity for patients required further surgical treatment.
ObjectivesTo evaluate the effects of Q-syte separating film needleless closed transfusion connector in flushing chamber of three-cavity urethral catheter.MethodsTo retrospectively analyze the patients who underwent transurethral resection of bladder tumor for non muscle-invasive bladder cancer from January 2015 to July 2016 in Zhongnan Hospital of Wuhan University. After terminating the continuous bladder irrigation, the observed group used Q-syte separating film needleless closed transfusion connector to seal the flushing chamber of three-cavity urethral catheter, and control group used conditional approach to connect drainage bag. The degree of comfort and satisfaction of patients, urinary tract infection, time of stopping bladder irrigation and bladder perfusion time between two groups were assessed.ResultsA total of 88 patients were included involving 63 (72%) males and 25 (28%) females with a mean age of 60.2±4.7 years. There were no significant differences between two groups in age, gender, BMI, and complications (P>0.05). Compared to control group, case group had higher level of comfort degree (mild discomfort: 86.4% vs. 25.0%, P<0.001; moderate discomfort: 13.6% vs. 52.3%, P<0.001; severe discomfort: 0.0% vs. 22.7%, P=0.001), satisfaction degree (97.9±2.1 vs. 84.5±3.9, P<0.001), and lower rates of urinary tract infection (11.4% vs. 29.5%, P=0.034). In addition, the case group spent shorter time in terminating bladder irrigation (50.48±1.78 vs. 207.74±5.41, P<0.001) and bladder perfusion (141.47±3.25 vs. 205.35±5.17, P<0.001). All differences were statistical significance.ConclusionsApplication of Q-syte separating film needleless closed transfusion connector for sealing flushing chamber of three-cavity urethral catheter after continuous bladder irrigation could promote the degree of comfort and satisfaction of patients, and decrease the rate of urinary tract infection, as well as the working efficiency of health care professionals.
ObjectiveTo observe and analyze the effect of peripore cavity size on visual function of macular area before and after surgery for idiopathic macular hole (IMH). MethodsA retrospective clinical study. From July 2020 to February 2021, a total of 25 patients with 25 eyes with monocular IMH (operation group) diagnosed by ophthalmology examination in Department of ophthalmology, Fourth Hospital of Hebei Medical University were included in the study. The control group was contralateral healthy eyes. All subjects were examined by best corrected visual acuity (BCVA), microfield of vision, frequency domain optical coherence tomography (SD-OCT), and OCT angiography (OCTA). The diameter of macular hole was measured by SD-OCT. The cystic morphology of deep capillary plexus (DCP) was detected by en face OCT, and the cystic area was measured by Image J software. MP-3 microperimeter was used to measure central macular retinal light sensitivity (MS) and mean macular retinal light sensitivity (MMS). Central macular retinal light sensitivity (CMS), MMS and cystic cavity MS were measured in the operation group. MMS was measured in the control group. The microperimetry images were superimposed on the DCP layer of OCTA to identify and calculate the average MS within the lumen and compare it with the control group. Standard three incisions were performed in all affected eyes by vitrectomy of the flat part of the ciliary body + stripping of the inner boundary membrane + intraocular sterile air filling. Three months after the operation, the same equipment and methods were used to perform relevant examinations. Paired sample t test was used to compare MS between operation group and control group. Pearson correlation analysis was used to analyze the correlation between capsular area, macular hole diameter before and after operation and MS before and after operation. The correlation between BCVA and capsular area before and after surgery was analyzed by Spearman correlation analysis. ResultsIn the surgical group, the retinal MS was (4.24±3.07) dB. The MMS of control group was (19.08±6.11) dB. The MS in the surgical group was significantly lower than that in the control group, and the difference was statistically significant (t=10.832, P＜0.01). Before operation, the area of cyst was (1.04±0.55) mm2, and the diameter of macular hole was (564.80±166.59) μm. CMS and MMS were (2.27±2.29) dB and (9.08±3.65) dB, respectively. The diameter of macular hole (r=0.50, P=0.010) and BCVA before operation (r=0.57, P＜0.001) were positively correlated with peripore cavity area. Before operation, CMS and MMS were negatively correlated with peripore cavity area (r=－0.53, －0.47; P=0.010, 0.020). At 3 months after surgery, the capsular area was negatively correlated with CMS and MMS (r=－0.65,－0.76; P=0.020, 0.030). There was no correlation with BCVA (r=0.23, P=0.470). ConclusionsRetinal MS is decreased in the peri-capsular area of IMH pore. There is a positive correlation between capsule area, BCVA and macular hole diameter before operation. The capsular area is negatively correlated with CMS and MMS before operation.
ObjectiveTo investigate the CT signs and clinicopathological features of peripheral cavitary lung adenocarcinoma with the largest diameter less than or equal to 3 cm.Methods From January 2015 to December 2017, the CT signs and clinicopathological fertures of 51 patients with ≤3 cm peripheral cavitary lung adenocarcinoma diagnosed by chest CT and surgical pathology were retrospectively analyzed. Furthermore, CT signs and clinicopathological features of thick-walled cavitary lung adenocarcinoma and thin-walled cavitary lung adenocarcinoma were compared. There were 29 males and 22 females at age of 62 (56, 67) years.ResultsThere were 27 thick-walled cavitary lung adenocarcinoma and 24 thin-walled cavitary lung adenocarcinoma. Thick-walled cavitary adenocarcinoma had greater SUVmax [6.5 (3.7, 9.7) vs. 2.2 (1.4, 3.8), P=0.019], larger cavity wall thickness (11.8±4.6 mm vs. 7.6±3.7 mm, P=0.001), larger tumor tissue size [2.1 (1.7, 2.8) cm vs. 1.6 (1.2, 2.0) cm, P=0.006], and more solid nodules (17 patients vs. 8 patients, P=0.035). Thin-walled cavitary adenocarcinoma had more smoking history (12 patients vs. 6 patients, P=0.038), larger cavity size [12.3 (9.2, 16.6) mm vs. 4.4 (2.8, 7.1) mm, P=0.000], and larger proportion of cavities [0.30 (0.19, 0.37) vs. 0.03 (0.01, 0.09), P=0.000]. On CT signs, there were more features of irregular inner wall (19 patients vs. 6 patients, P=0.000), intra-cystic separation (16 patients vs. 6 patients, P=0.001) and vessels through the cystic cavity (10 patients vs. 1 patient, P=0.001) in thin-walled caviraty lung adenocarcinoma.ConclusionPeripheral cavitary lung adenocarcinoma of ≤3 cm on chest CT has characteristic manifestations in clinical, imaging and pathology, and there is a statistical difference between thick-walled cavitary lung adenocarcinoma and thin-walled cavitary lung adenocarcinoma.
Anti-vascular endothelial growth factor (VEGF) drugs have been widely used in clinic by inhibiting angiogenesis to treat ocular diseases such as malignant tumors and diabetic retinopathy. However, recent studies have shown that intravitreal injection of anti-VEGF drugs may have significant systemic absorption, leading to a series of renal damages such as worsening hypertension, proteinuria, new glomerular disease, and thrombotic microangiopathy. This article reviews the renal toxicity of intravitreal injection of anti-VEGF drugs in the treatment of diabetic retinopathy and other ocular diseases, aiming to provide recommendations for clinicians.
Objective To study the effect of the intracavity thrombolysis, aspiration of debris, percutaneous transcathete angioplasty (PTA) and percutaneous transtuminl angioplasty and stenting (PTAS) on treating peripheral arterial obliterans disease (PAOD). Methods From May 1994 to May 2008, interventional treatment was performed in 285 patients with PAOD. Intracavity thrombolysis and aspiration of debris were performed in 63 patients suffering from acute arterial occlusion. Intracavity thrombolysis and PTA were performed in 61 patients suffering from arteriostenosis combined with acute occlusion. Intracavity thrombolysis, PTA and PTAS were performed in 161 patients suffering from chronic arteriostenosis occlusion. Results Total success rate was 98.25% (280/285). The success rate in intracavity thrombolysis and aspiration of debris was 96.83% (61/63), with 88.89% (56/63) of the blood vessels restored, 7.94% (5/63) of the blood vessels partially restored, and another 3.17% (2/63) failed. The success rate in intracavity thrombolysis and PTA was 85.25% (52/61). The success rate in PTA and PTAS was 98.14% (158/161). The total complication rate was 7.02% (20/285), of them the local thrombolysis and thromboclasis accounting for 7.94% (5/63), the local thrombolysis and PTA accounting for 14.75% (9/61), the PTA and stent implantation accounting for 3.73% (6/161). Conclusion Percutaneous transluminal treatment for stenotic and occlusive lesions of peripheral artery can effectively keep the blood vessel unobstructed for a long time and raise the haemodynamics index remarkably.
ObjectiveTo explore the clinical efficacy and application significance of continuous irrigation and drainage for intestinal fistula combined with abdominal infection.MethodsClinical data of 62 patients with intestinafistula combined with abdominal infection admitted by Department of General Surgery of The 940th Hospital of The People’s Liberation Army Joint Service Support Force from March 2012 to March 2017 were retrospectively analyzed. All patients were treated with continuous abdominal flushing and drainage after emergency surgery. The duration of peritoneal flushing, antibiotic use, blood picture recovery, fistula healing, and total hospitalization were summarized.ResultsAll 62 patients were treated successfully without death or septic shock. Among them, 49 cases of intestinal fistula were treated with continuous abdominal flushing and drainage, and 13 cases of intestinal fistula were treated by continuous flushing and drainage of the abdominal cavity. There were 6 cases of abdominal abscess, 5 cases of incision infection, 5 cases of pleural effusion, and 2 cases of pulmonary infection after surgery. The continuous abdominal cavity washing time was (45±21) d, antibiotic use time was (14±7) d, blood image recovery time was (16±8) d, the healing time of fistula was (47±24) d, total length of hospital stay was (56±27) d.ConclusionsFor intestinal fistula combined with abdominal cavity infection, peritoneal continuous flushing and drainage is related with curative effect, high cure rate, fewer complications, simple washing equipment, simple technology, lower cost, and convenient nursing, which can create a good condition for the complexity or refractory patients with intestinal fistula, and has a high clinical application significance.