Empowering families facing end-stage nonmalignant chronic diseases with a holistic, transdisciplinary, community-based intervention: 3 months outcome of the Life Rainbow Program.

OBJECTIVES: Families facing end-stage nonmalignant chronic diseases (NMCDs) are presented with similar symptom burdens and need for psycho-social-spiritual support as their counterparts with advanced cancers. However, NMCD patients tend to face more variable disease trajectories, and thus may require different anticipatory supports, delivered in familiar environments. The Life Rainbow Programme (LRP) provides holistic, transdisciplinary, community-based end-of-life care for patients with NMCDs and their caregivers. This paper reports on the 3-month outcomes using a single-group, pre-post comparison. METHOD: Patients with end-stage NMCDs were screened for eligibility by a medical team before being referred to the LRP. Patients were assessed at baseline (T0), 1 month (T1), and 3 months (T2) using the Integrated Palliative Outcome Scale (IPOS). Their hospital use in the previous month was also measured by presentations at accident and emergency services, admissions to intensive care units, and number of hospital bed-days. Caregivers were assessed at T0 and T2 using the Chinese version of the Modified Caregiver Strain Index, and self-reported health, psychological, spiritual, and overall well-being. Over-time changes in outcomes for patients, and caregivers, were tested using paired-sample t-tests, Wilcoxon-signed rank tests, and chi-square tests. RESULTS: Seventy-four patients and 36 caregivers participated in this research study. Patients reported significant improvements in all IPOS domains at both 1 and 3 months [ranging from Cohen's d = 0.495 (nausea) to 1.793 (depression and information needs fulfilled)]. Average hospital bed-days in the previous month fell from 3.50 to 1.68, comparing baseline and 1 month (p < 0.05). At 3 months, caregiver strain was significantly reduced (r = 0.332), while spiritual well-being was enhanced (r = 0.333). SIGNIFICANCE: After receiving 3 month's LRP services, patients with end-stage NMCDs and their caregivers experienced significant improvements in the quality of life and well-being, and their hospital bed-days were reduced.

[Current status and prospects of studies on biological occupational hazards].

Biological occupational hazards have occurred frequently for a long time, which have seriously affected the health of relevant occupational groups. The infection of medical staff caused by improper occupational protection in public health emergencies also sounds alarms to practitioners with biological hazards. In order to further carry out the research work of biological occupational hazards, this paper combs and summarizes the research status of biological occuational hazards in agriculture, forestry, animal husbandry, fishery and other industries, and puts forward suggestions for in-depth research from three aspects of research scope, research methods and research contents, to provide some reference for the development of biological occupational hazards research in the future.

[Cause analysis and treatment strategies of "recurrence" with novel coronavirus pneumonia (COVID-19) patients after discharge from hospital].

With a large number of COVID-19 patients discharging from hospital, some had showed re-fever and positive nucleic acid test after discharge from hospital. This might be due to the biological characteristics of 2019-nCoV, and might also be related to the basic disease, clinical status, glucocorticoid using, sample sampling, processing and detecting of patients, and some even related to the re-infection or secondary bacterial virus infection. Therefore, we suggest that in view of this phenomenon, further stratified management of discharge from hospital should be carried out on the basis of guidelines, especially for patients with advanced age, underlying diseases or severe or critical pneumonia. For those patients who can't completely deoxygenate for a long time after hospitalization, individualized treatment methods and different discharge evaluation criteria should be adopted to ensure the complete cure of patients and prevent recurrencing after discharge from hospital.

[Low power seven-step two-lobe holmium laser enucleation of the prostate technique for surgical treatment of benign prostatic hyperplasia].

OBJECTIVE: To evaluate the safety and efficacy of the seven-step two-lobe holmium laser enucleation of the prostate (HoLEP) technique with low power laser device, and to introduce the detailed operating procedures, key points, short-term outcomes of this modified HoLEP technique. METHODS: From March 2016 to November 2017, 90 patients underwent HoLEP in Peking University Third Hospital. The patients were divided into two groups: high-power group (32 patients) were performed with traditional Gilling's three-lobe enucleation using high power (90 W) laser; Low-power group (58 patients) were performed with seven-step two-lobe enucleation using low power (40 W) laser. The main steps of the low power seven-step two-lobe HoLEP phase included: (1) The identification of the correct plane between adenoma and capsule at 5 and 7 o'clock laterally to the veru montanum; (2) The connection of the bilateral plane by making a adenoma incision at the proximal point of veru montanum; (3) The extension of the dorsal plane under the whole three lobes between adenoma and capsule towards the bladder neck; (4) The separation of the middle lobe from two lateral lobes by making two retrograde incisions separately from apex 5 and 7 o'clock towards the bladder neck; (5) The enucleation of the middle lobe adenoma by extending the dorsal plane through into the bladder; (6) The prevention of the apex mucosa by making a circle incision at the apex of the prostate; (7) The en-bloc enucleation of the two lateral lobe adenomas by extending the lateral and ventral plane between adenoma and capsule from 5 and 7 o'clock to 12 o'clock conjunction and through into the bladder. RESULTS: The mean patient age was (66.25±5.37) years vs. (68.00±5.18) years; The mean body mass indexes were (24.13±4.06) kg/m2 vs. (24.57±3.50) kg/m2; The mean prostate specific antigen values were (3.23±2.47) µg/L vs. (6.00±6.09) µg/L; The average prostatic volumes evaluated by ultrasound was (49.03±20.63) mL vs. (67.55±36.97) mL. There was no significant difference between the two groups. Furthermore, there were no significant differences in terms of perioperative and follow up data, including operative time; enucleation efficiencies; hemoglobin decrease; blood sodium and potassiumthe change postoperatively; catheterization duration and hospital stay; the international prostate symptom scores and quality of life scores pre- and post-operatively. There was 1 transurethral resection of the prostate (TURP) conversion in high-power group and 1 transfusion in low-power group during the operations. The follow-up one month after operation showed no severe stress incontinence in both the groups, whereas 3 cases ejaculatory dysfunctions in high-power group versus 1 case in low-power group were observed; Other surgeryrelated complications included: 2 cases postoperative hemorrhage (Clavien II and Clavien IIIb) in high-power group, 2 cases postoperative temperature more than 38 °C (Clavien I) and 1 case dysuria following catheter removal (Clavien I) in low-power group. CONCLUSION: Low power laser device can be applied safe and effectively for HoLEP procedure using the seven-step two-lobe HoLEP technique. The outcomes comparable with high power laser HoLEP can be achieved.

[Two-stage total hip arthroplasty using an antibiotic-loaded cement spacer for infected internal fixation of hip fractures].

Objective: To evaluate the application and clinical results of two-stage total hip arthroplasty in the treatment of the deep hip infection following the internal fixation of hip fractures. Methods: From May 2007 to November 2014, 21 patients with active hip infection secondary to internal fixation of hip fractures were treated with two-stage total hip arthroplasty using a temporary antibiotic-loaded cement spacers. Of 21 cases, 15 were males and 6 were females, aged from 27 to 64 years (mean, 45); there are 18 cases of femoral neck fractures and 3 cases of intertrochanteric fractures. The serologic examination and X-ray were taken at 1 month, 3 months, 6 months, 12 months and annually thereafter post-operatively to evaluate the clinical results and prosthesis status. Harris hip score system was used to evaluate the joint function. Results: All patients were successfully treated with two stage operations under general anesthesia. The operational interval was 12-44 weeks (mean, 21) and 1 spacer breakage. For the arthroplasty, cementless components were used in 20 cases and cemented component was use in 1 case. The patients were followed up 25-102 months ( mean, 55 ) and infections were eradicated in all hips. The Harris hip score was improved from 23.24±11.81 pre-operatively to 90.24±3.92 post-operatively and the difference was statistically significant (P<0.05). According to this scoring criteria, the excellent and good rate reached up to 95%. At latest fellow-up, the location of prosthesis were well and the function of hip joint was satisfied. All cases had no dislocation, periprosthetic fracture, ectopic ossification or any other complications at the latest fellow-up. Conclusion: By means of an antibiotic-loaded cement spacer, two-stage total hip arthroplasty is an effective salvage procedure eradicating infection and providing functional improvement to the infected internal fixation of hip fractures. The early and mid-term clinical effects are satisfied.

A randomized controlled trial of self-regulated modified constraint-induced movement therapy in sub-acute stroke patients.

BACKGROUND AND PURPOSE: Emerging research suggests the use of self-regulation (SR) for improving functional regain in patients post stroke. SR is proposed to produce an added effect to effective modified constraint-induced movement therapy (mCIMT). This study aimed to examine the effect of a self-regulated mCIMT programme (SR-mCIMT) for functional regain in patients with sub-acute stroke. METHODS: Eighty-six patients completed the trial: SR-mCIMT, n = 29; mCIMT, n = 31; or conventional functional rehabilitation, n = 26. All interventions were 2-week therapist-guided training. Outcome measurements, taken by a blinded assessor, examined arm function [Action Research Arm Test (ARAT), Fugl-Meyer Assessment (FMA)], daily task performance [Lawton Instrumental Activities of Daily Living Scale (Lawton IADL)] and self-perceived arm use in functional tasks [Motor Activity Log (MAL)]. RESULTS: Significant differences were found with the SR-mCIMT outperforming the other groups after the intervention (ARAT, P = 0.006; FMA, Lawton IADL and MAL, all Ps < 0.001). In terms of the carry-over effect, the SR-mCIMT group outperformed in the hand and coordination subscales of ARAT and FMA (P = 0.012-0.013) and the self-perceived quality of arm use (P = 0.002). CONCLUSION: A combination of SR and mCIMT could produce an added effect in functional regain in patients post stroke.

Role of iron in lung injury-induced by hyperoxia.

Iron is essential to life due to its unusual flexibility in serving as both an electron donor and acceptor. However, free iron can damage tissues by catalyzing the conversion of hydrogen peroxide to free-radical ions that attack lipids, proteins and DNA. Hyperoxia-induced lung injury (HILI) occurs when breathing elevated partial pressure of oxygen (usually > 0.5 atmospheres absolute) for extended periods. A few studies have shown that iron and proteins related to iron metabolism are closely related to HILI, and iron chelation may exert protective effects on HILI. As a rate-limiting enzyme in the degradation of heme, heme oxygenases (HOs) play a crucial role in the iron metabolism. Although some studies have been conducted to investigate the role of HOs in the pathogenesis of HILI, findings still conflict, and HOs of different isoforms may function differently in the pathogenesis of HILI. On the available findings, there might be a beneficial threshold of HO-1 expression in HILI. More studies are required to confirm the above findings and to provide evidence for the clinical treatment of HILI by iron chelation.

High ligation of the fistula track by lateral approach: a modified sphincter-saving technique for advanced anal fistulas.

AIM: Ligation of the intersphincteric fistula track is a novel surgical procedure with the advantage of avoiding anal incontinence. We conducted a preliminary investigation of a modified technique for complicated trans-sphincteric anal fistula by high ligation of the track using a lateral approach. METHOD: From June 2010 to May 2011, 10 patients received high ligation of the fistula track using a lateral approach. Patients selected for the procedure had a mature trans-sphincteric type of anal fistula that involved a significant amount of the external sphincter. Patients with early fistulous abscess or with a history of previous anal surgery were excluded. The surgical technique involved making an incision from the external opening and extending this towards the direction of the internal opening, dissection of the fistula from the underlying soft tissue, high ligation above the internal sphincter and removal of the distal part of the fistula track for pathological examination. RESULTS: Of the 10 patients, eight were men and the mean ± SD age was 40.5 ± 7.23 years. The median (range) duration of follow-up was 7 (6-10) months. In all patients, the wound was completely healed by the sixth postoperative week. Two cases of recurrence were noted later and were successfully managed by traditional fistulotomy. CONCLUSION: High-ligation surgery of the fistula track for trans-sphincteric anal fistula, aimed at total anal sphincter preservation, has shown encouraging early results. Long-term follow-up and randomized controlled trials are necessary.

[Spatial epidemiology plays an important role in control and prevention of diseases].

Spatial epidemiology is a new branch of epidemiology that aims to map the spatial distribution and characteristics as well as to explore the associated influencing factors of diseases by using the geographic information system and other spatial technologies. In recent years, with the rapid development of information-related modern technology, improvement of accessibility on health - related services, natural environment, social and economic big data etc., spatial epidemiology has made considerable progress in both theory and practice and played more important roles in the public health area of China.

[Experience of low calcium crisis after the operation in peritonea dialysis secondary].

We report a case of secondary hyperparathyroidism after peritoneal dialysis. After given the total parathyroidectomy and forearm autoplantation (PTX+AT), the patient presented with an acute low calcium crisis (tongue myoparalysis, tetany and ECG abnormalities). As the conventional calcium treatment was invalid, the calcium solution was then changed, and replaced by the standard calcium dialysate with monitoring calcium ions. At the last, the patient was rescued. After a long term followed up, the patient's clinical symptoms were improved, and the parathyroid hormone (iPTH) level basically kept within the scope of the KDIGO guidelines.

The assessment of the long-term effects of elective CRT-D of coronary heart disease after PCI.

OBJECTIVE: The present study was planned to evaluate the long-term effects of elective cardiac resynchronization therapy devices (CRT-D) of coronary heart disease after percutaneous coronary intervention (PCI). PATIENTS AND METHODS: We continuously selected 124 patients with chronic stable heart failure to undergo PCI, and were randomly divided into two groups viz. control group with 72 cases and observation group with 52 cases. The control group was given intensive drugs, while the observation group was treated with a combination of intensive drugs with CRT-D. Followed-up for three years and contrasted their effects. RESULTS: The survival rate of the observation group was significantly higher than that of the control group, and its major adverse cardiac events (MACE) rate was observed to be lower than that of the control group. During the follow-up of the control group, LVEDd, pro-BNP and NYHA increased but LVEF decreased. On the other hand, in the observation group, LVEDd, LVEF, NYHA showed no significant changes, but pro-BNP revealed a significant increase. The physical health, mental health, social health and total score of the observation group were significantly higher than that of the control group. CONCLUSIONS: Patients with chronic stable heart failure who have CRT-D implant testified after PCI could have significant improvement in long-term survival rate, better quality of life, improved cardiac function and reduction in the occurrence of MACE too.

Why we consistently use the left donor kidney in living related transplantation: initial experience of right laparoscopic donor nephrectomy and comparison with left nephrectomy.

OBJECTIVES: Laparoscopic donor nephrectomy has become the method of choice for removal of living donor kidneys. However, the majority of laparoscopic donor nephrectomy cases have been limited to the left side owing to technical difficulties and renal vessel length. This study described the technique and compared donor outcomes and graft function of right and left laparoscopic donor nephrectomy. MATERIALS AND METHODS: Among 25 patients, 6 consecutive donors underwent right laparoscopic donor nephrectomy from March 2002 to January 2005. They were compared to 19 patients with left laparoscopic donor nephrectomy. We compared operative times, warm ischemia times, serial creatinines, creatinine clearances, complications, and graft function. RESULTS: There was no significant difference in any metric. The operative times (303 min. vs 274 min., P > .05) and warm ischemia times (133 s vs 186 s, P > .05) were similar between right and left laparoscopic donor nephrectomy procedures. In left laparoscopic donor nephrectomy, 3 patients had transient brachial plexus neuropathies. No major complication occurred among patients undergoing right laparoscopic donor nephrectomy. This study demonstrated that both donor and recipient outcomes are similar for right and left laparoscopic donor nephrectomy. CONCLUSIONS: Consistent use of the left kidney has not affected clinical outcomes. With hand-assisted laparoscopy, the right laparoscopic donor nephrectomy is safe, providing excellent graft function.

Meta-analysis of the efficacy of proton pump inhibitors for the symptoms of laryngopharyngeal reflux.

The objective of this study was to perform a systematic review and meta-analysis to assess the effectiveness of proton pump inhibitors (PPI) for reflux disease in adult patients with laryngopharyngeal symptoms. A comprehensive search of Cochrane Library, EMBASE, Ovid EBM Reviews, and PubMed was performed for English-language literature about laryngopharyngeal reflux (LPR), in September 2014. The papers were filtered using pre-defined inclusion and exclusion criteria. Eight papers were identified and included in this meta-analysis. The sample comprised a pooled total of 370 patients, of which 210 and 160 patients took PPIs and placebo, respectively. The difference between PPIs and placebo groups in overall improvement of symptoms in adult patients with LPR was not statistically significant (RR=1.22; 95%CI=0.93-1.58; P=0.149). The difference in cough improvement was also not significant between PPIs and placebo groups (RR=0.65; 95%CI=0.30-1.41; P=0.279).

Individual design of the anterolateral thigh flap for functional reconstruction after hemiglossectomy: experience with 238 patients.

The aim of this study was to evaluate tongue function in patients with oral cancer treated surgically and reconstructed with anterolateral thigh free flaps (ALTFs). Patients (N=238) underwent primary reconstruction after hemiglossectomy between September 2012 and October 2014. Patients were divided into two groups according to the flap design: 'individual design' (ABC flap) and 'common design'. Patients were followed postoperatively and assessed after 6 months for the following functional outcomes: speech, deglutition, tongue mobility, and donor site morbidity. Intelligibility and deglutition were each scored by an independent investigator. Data were analyzed using SPSS version 16.0 software. No differences in mean speech intelligibility scores were observed between the two groups (good: P=0.908; acceptable: P=0.881). However, the ABC flap offered recovery advantages for swallowing capacity compared to the common design flap (MTF classification good: P=0.028; acceptable: P=0.001). The individualized ABC flap not only provides volume but also preserves mobility, speech intelligibility, and swallowing capacity. ALTFs require further improvement for the individualized functional reconstruction of the tongue after hemiglossectomy, but this work lays the foundation for these improvements.