Doppler-guided hemorrhoidal artery ligation with suture mucopexy compared with LigaSure™-assisted pile excision for the treatment of grade III hemorrhoids: a prospective randomized controlled trial.

BACKGROUND: Doppler-guided hemorrhoid artery ligation and stapled hemorrhoidopexy have been used in surgical practices to avoid post-hemorrhoidectomy pain. Our study compared Doppler-guided hemorrhoid artery ligation with suture mucopexy (DGHAL-SM) and ligature-assisted pile excision (LAP) for greater than three grades of internal hemorrhoids. METHODS: Eighty patients with greater than 3 grades of internal hemorrhoids were selected (age range: 20-28 years; average age: 23 years) between January and June 2015. The patients were randomly divided into group A (DGHAL-SM) and group B (LAP); each group had 40 patients. RESULTS: With respect to the postoperative cure rate and anal skin tags, group A was inferior to group B, but the postoperative pain assessment and satisfaction were better than group B (P<0.001). CONCLUSIONS: The DGHAL-SM cure rate was high; the postoperative pain was mild; 97.5% of the patients did not return to hospital because of pain. LAP has a higher cure rate than DGHAL-SM, but the postoperative pain and return rate within 6 h was as high as 65%, and the postoperative satisfaction assessment was lower than DGHAL-SM. Therefore, we recommend that DGHAL-SM for outpatient surgery in patients with greater than three grades of internal hemorrhoids.

Younger, more senior, and most vulnerable? Interaction effects of age and job seniority on psychological distress and quality of life among firefighters.

OBJECTIVES: Firefighters are exposed to repeated traumatic events while the robustness of cumulative effects of repeated exposure to trauma on psychological distress among them are inconsistent. Considering the length of service and seniority are risk factors, the purpose of this study was to examine the effects of the interaction between age and seniority on psychological distress and quality of life among firefighters. METHODS: Participants were 229 firefighters of the Hualien County Fire Bureau in Taiwan who worked full time in response to emergency services and disaster rescues activities. Probable posttraumatic stress disorder (PTSD), depression, anxiety, agoraphobia, and quality of life were assessed among firefighters using psychodiagnostics questionnaires. Firefighters were stratified based on age into a young and a mature group, and based on length of service into a junior and a senior group, yielding four groups: "young-senior," "young-junior," "mature-senior," and "mature-junior." RESULTS: A majority of the firefighters were dissatisfied with their health condition. All the firefighters scored relatively lower at the social domain of their quality of life compared with physical, emotional, and environment domains. In the post hoc multiple comparison analysis, the young-senior firefighters were found to be most vulnerable to psychological distress, manifested in having a higher prevalence of, and suffering from more, severe probable PTSD, depression, anxiety, and agoraphobia symptoms than the other groups of firefighters. CONCLUSIONS: Age and job seniority have significant effects on psychological distress among firefighters. Being young and starting young to serve as a firefighter for a relatively long time is a significant risk factor for psychological distress. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Elevated Plasma Levels of Gas6 Are Associated with Acute Lung Injury in Patients with Severe Sepsis.

Acute lung injury (ALI) is one of the complications of severe sepsis, causing sudden deaths. However, information regarding predictive factors for the onset of ALI in severe sepsis is limited. Growth arrest-specific gene 6 (Gas6) is secreted by endothelial cells and is important for the activation of endothelium during inflammation. This study aimed to investigate the predictive effect of plasma Gas6 in patients with severe sepsis. Collection of plasma samples was carried out from 129 participants with severe sepsis following with or without ALI development. We found that the elevated levels of Gas6, interleukin-6 and -8 (IL-6 and IL-8) in plasma were associated with the ALI development (P = 0.003, 0.002, and 0.004, respectively). We also observed the robust correlation between the plasma level of Gas6 and the following ALI development to adjustment for sepsis and administration of vasopressor. Between patients with ALI (n = 18) and those without ALI (n = 111), Gas6 and the Lung Injury Prediction Score (LIPS) showed promising discrimination (AUROC, 0.74 and 0.68, respectively), and in combination with these two indexes, the AUROC was increased to 0.86 (vs. 0.74, P = 0.05), while soluble receptor for advanced glycation end products (sRAGE) and Willebrand factor (vWF) in plasma showed no predictive value for of ALI. Collectively, our findings indicate that higher levels of Gas6 in plasma are obviously correlated with ALI development. An early increase in the plasma Gas6 level suggests that endothelial injury is a key link in the pathogenesis of ALI.

Nasogastric tube placement with video-guided laryngoscope: A manikin simulator study.

BACKGROUND: This study aimed to investigate video-guided laryngoscopy for nasogastric tube placement. METHODS: This was an observational comparative study performed in a hospital. The participants included volunteers from the medical staff (physicians and nurses) experienced with nasogastric intubation, and non-medical staff (medical students, pharmacists and emergent medical technicians) with knowledge of nasogastric intubation but lacking procedural experience. Medical and non-medical hospital staff performed manual, laryngoscope-assisted and video-guided laryngoscope nasogastric intubation both in the presence and in the absence of an endotracheal tube, using a manikin. Nasogastric intubation times were compared between groups and methods. RESULTS: Using the video-guided laryngoscope resulted in a significantly shorter intubation time compared to the other 2 methods, both with and without an endotracheal tube, for the medical and non-medical staff alike (all p < 0.05). For the medical staff, mean nasogastric intubation time was significantly shorter using video-guided laryngoscope without endotracheal intubation, direct laryngoscope with endotracheal intubation and video-guided laryngoscope with endotracheal intubation compared to manual intubation without endotracheal intubation (0.49, 0.63 and 0.72 vs. 5.63, respectively, p ≤ 0.008). For non-medical staff, nasogastric intubation time was significantly shorter using video-guided laryngoscope without endotracheal intubation, direct laryngoscope with endotracheal intubation and video-guided laryngoscope with endotracheal intubation compared to manual intubation without endotracheal intubation (1.67, 1.58 and 0.95 vs. 6.9, respectively, p ≤ 0.002). And mean nasogastric intubation time for video-guided laryngoscope endotracheal intubation was significantly shorter for medical staff than for non-medical staff (0.49 vs. 1.67 min, respectively, p = 0.041). CONCLUSION: Video-guided laryngoscope reduces nasogastric intubation time compared to manual and direct laryngoscope intubation, which promotes a consistent technique when performed by experienced medical and previously untrained non-medical staff.