[A clinical study of high dependency units to reduce ICU readmission rates in patients with severe liver disease].

Objective: To investigate the real-world difference in the ICU readmission rate between the high-dependency unit (HDU) and the general ward so as to reflect the role of HDU in the diagnosis and management of patients with SLD. Methods: Patients with severe liver disease who were consecutively enrolled were step-downed to HDU and general wards in the ICU of the Fifth Medical Center of the People's Liberation Army General Hospital between July 2017 and December 2021. The main liver function indicators, MELD scores, and other were compared between the two groups. SLD severity, ICU readmission rates, and others differences were analyzed among the patients transferred to different wards. The HDU role was clarified for SLD patients' grade management. The area under the curve of the receiver operating characteristic curve (AUROC) was used to calculate and explore the feasibility of a baseline Model for End-Stage Liver Disease (MELD) score to define the treatment scope of HDU. Results: The SLD group of patients who were transferred to HDU had significantly higher levels of the international normalized ratio, bilirubin, alanine aminotransferase, MELD score, and other factors compared to those in the general ward (P < 0.05). 70.7% of SLD patients in the HDU group had a MELD score > 17, while 61.9% of SLD patients in the general ward group had a MELD score ≤ 17. The overall ICU readmission rate in this cohort was 11.4%. The ICU readmission rate was significantly higher with a MELD score of > 23 (20.0%) than that with a MELD score of ≤ 23 (8.6%) in patients with SLD, according to the MELD score quartile P75 (P = 0.020). The ICU readmission rate was 8.2% when MELD score ≤ 23, and 9.1% when MELD score>23 in the HDU group, with no statistically significant difference (P = 1.000). However, in the general ward group, the ICU readmission rate in patients with a MELD score ≤ 23 was 8.8%, and when the MELD score was >23, the ICU readmission rate significantly increased to 36.4% (P = 0.001). The optimal cut-off value of the MELD score for predicting ICU readmission in patients with SLD in the general ward group was 23.5. Conclusion: The high-dependency unit can better undertake ICU step-down patients with SLD and significantly reduce the ICU readmission rate with MELD scores > 23 in practice. Additionally, ICU step-down SLD patients with a MELD score > 23 are suitable for transfer to HDU treatment.

[Mechanism of action for oligomeric proanthocyaniclins in pava qnat-induced acute lung injury].

Objective: The present study was designed to evaluate the protective effects of oligomeric proanthocyanidins (OPC) in mice exposed to paraquat (PQ) , and to explore the molecular mechanism. Methods: Four experimental groups were designed. CONTROL GROUP: 10 BALB/c mice were intraperitoneally injected with normal saline) . PQ group: 10 BALB/c mice were intraperitoneally injected with PQ (100 mg/kg) . PQ+OPC group: 10 BALB/c mice were administered with OPC (100 mg/kg) for 1 h before PQ (100 mg/kg) expo-sure. OPC group: 10 BALB/c mice were intraperitoneally injected with OPC (100 mg/kg) . The peripheral blood samples or lung tissue samples were collected at the designed time points for measuring the levels of oxi-dative stress indicators, the related protein levels of nuclear factor-kappa B (NF-κB) pathway and nuclear fac-tor erythroid related factor-2 (Nrf2) pathway. Results: Compared with the control group, the level of reactive oxygen species (ROS) , the content of malondialdehyde (MDA) in the PQ group were significantly induced, and the activity of superoxide dismutase (SOD) in the PQ group was decreased in the peripheral blood. As com-pared with the PQ group, the level of ROS and the content of MDA in the PQ+OPC group were significantly re-duced, the activity SOD in the PQ+OPC group was increased in the peripheral blood; the level of ROS and the content of MDA were also reduced in lung tissues in the PQ+OPC group. Moreover, compared with the con-trol group, the phosphorylation of IκBα and the expression of NF-κB p65 were increased in lung tissues in the PQ group. The phosphorylation of IκBα and the expression of NF-κB p65 were decreased in lung tissues in the PQ+OPC group as compared with the PQ group. In addition, compared with the control group, the expressions of HO-1 and Nrf2 were increased in lung tissues in OPC group, and these were decreased in lung tissues in PQ groups. Furthermore, the expressions of HO-1 and Nrf2 were also increased in lung tissues in PQ+OPC as com-pared with the PQ group. Conclusion: OPC could alleviate PQ-induced systemic toxicity in mice by regulating oxidative stress via NF-κB and Nrf2 pathway.

[Diagnosis and surgical treatment of early esophageal carcinoma--analysis of 7 cases].

Misdiagnosis and negligence are common in the diagnosis of early esophageal carcinoma because of the minute lesion, mild symptoms and faulty examination. Analysis of 7 cases showed that the symptoms, cytologic, X-ray and endoscopic examinations are all very important. They can be used to check the findings of one another and none of them should be neglected or over-emphasized. Negative result of one cannot refute the positive findings of the others. Multi-focal tendency of esophageal carcinoma makes pan-esophagectomy advisable. Our experiences show that the diagnosis should be established by two cytological check up and the site of lesion determined with endoscopic examination or collected cytologic specimens at different levels of the esophagus. Supplemental X-ray findings and clinical symptoms can be helpful and careful inspection of the specimen during operation is necessary. Three of these 7 patients survived free of disease for 7,8 and 9 years, respectively. One patient died of fatal diarrhea 4 years after operation. The rest 3 died within 2 years of metastasis.

[Long-term results of surgical resection of early esophageal and cardiac carcinomas].

204 patients with early esophageal and cardiac carcinomas were treated surgically. The survival rate of 5, 10, 15, 20 and over 25 years was 92.6%, 71.6% 62.7%, 50.9% and 48.0% respectively. Follow-up for 10-26 years showed that 88 patients died (13 lost to follow-up). Recurrent esophageal carcinoma accounted for 29.5% (26 Patients) and carcinoma of the second organ 21.6% (19). In this group, 4 patients with early infiltration carcinoma died from extensive metastasis after operation and 88.4% early esophageal carcinoma showed multiple foci. We consider that the principles for radical resection should also be followed for early esophageal carcinoma.

[Dilatation of stricture of anastomosis after reconstruction of esophagus].

This article reports the experience of the esophagus dilating technique in the treatment of 658 cases of postoperative anastomotic stricture for esophageal cancer and cardiac cancer during the period from May 1983 to May 1993, being delated add up to 3240 times with total effective rate 96.5%, among them 61.6% of the cases less than five, 84.5% of the cases less than ten. Of them, 27 cases (4.1%) had postoperative complications, of which the main ones were esophagus perforation 8 cases (1.2%), hemorrhage of anastomotic stoma 4 cases (0.6%), mediastinitis 1 case (0.2%) and loca trauma 14 cases (2.1%). The operative indication, surgical technique and complication were discussed.

Results of surgical treatment in 6,123 cases of carcinoma of the esophagus and gastric cardia.

Six thousand one hundred twenty-three cases of carcinoma of the esophagus and gastric cardia were treated surgically from 1965 to 1985. Overall resectability was 89.9%. Postoperative mortality was 3%, and incidence of postoperative complication, 10.3%. Follow-up rate was 91.3%, with 5 year survival of 36.8% (esophageal nearly twice that of gastric cardia), and 10 year survival of 17.2%. Factors affecting long-term survival were clinicopathologic staging and preoperative irradiation. Early discovery and timely treatment are the key to high resectability and improved long-term survival. More efficacious combined therapies are needed for the predominant late cases. We propose more radical resection because of the multifocal tendency of esophageal and extensive submucosal infiltration of cardia carcinoma. Continuing refinements of surgical technique helped to reduce postoperative leakage and structure.