[Safety and feasibility of robotic-assisted thoracoscopic day surgery for pulmonary nodules: a retrospective analysis based on propensity score matching].

Objective: To evaluate the safety and feasibility of robotic-assisted thoracoscopic day surgery for pulmonary nodules. Methods: Clinical data of 523 patients with pulmonary nodule underwent robotic-assisted thoracoscopic surgery in the Department of Thoracic Surgery, Xiangya Hospital, Central South University from January 2021 to June 2022 were retrospectively analyzed, which including 223 males and 300 females, aged from 19 to 72 (54.0±11.7) years. Those patients were divided into the day surgery group (DSG) and inpatient surgery group (ISG) according to perioperative management methods. Propensity score matching (PSM) (1∶2) was performed according to the general baseline information, T stage of the tumor, surgery approach, and tumor position, and a total of 178 patients were finally included. Clinical outcomes of DSG were observed. The differences in incidence of postoperative complications, treatment-related costs and resource consumption between DSG and ISG were compared. Subgroup analysis was performed according to surgery method to evaluate the difference between DSG and ISG in lobectomy and sublobectomy. Results: In 81 cases DSG, eight patients were transferred to thoracic surgery ward, and the day surgery discharge rate was 90% (73/81). There was no statistically significant difference in incidence of postoperative complications between DSG and ISG (P=0.612). The length of stay after surgery, period of chest draining, average hospital cost, and drug cost of DSG were statistically significant lower than ISG, ((2.19±0.84) vs (4.74±1.81) days, (1.70±0.65) vs (3.45±1.85) days, (6.64±0.74) vs (8.29±0.97)×104 CNY, (0.35±0.07) vs (0.69±0.18)×104 CNY), respectively(all P<0.05). The drainage volume and VAS score at discharge in DSG and ISG group were(220.47±120.02) ml and(242.21±129.96) ml, 1.68±0.79 and 1.64±0.91, respectively, with no statistically significant difference (P>0.05). In subgroup analysis, there was no statistically significant difference in incidence of postoperative complications, drainage volume after surgery and VAS score at discharge between DSG and ISG both for lobectomy and sublobectomy patients. And the results of the length of stay after surgery, period of chest draining, and drug cost in DSG were also significantly lower than ISG (P<0.05). Conclusions: Robotic-assisted thoracoscopic day surgery for pulmonary nodule is safe and feasible, with the advantage of short length of stay after surgery, short period of chest draining, less average hospital cost and drug cost. There is no difference in incidence of postoperative complications between DSG and ISG.

[Initial exploration of transfusion-free liver transplantation].

Objective: To evaluate the effect of transfusion-free techniques on the prognosis of liver transplant patients. Methods: The recipients of adult liver transplantation at Tianjin First Central Hospital from August to December 2019 were included in the clinical observation. Liver transplantation without allogeneic blood transfusion was performed through anesthesia management techniques such as acute hemodilution or phlebotomy without volume replacement,maintaining decreased baseline central venous pressure and cell saver. According to the actual results,the patients were divided into two groups: transfusion-free group(n=21) and allogeneic transfusion group(n=28). There were 13 males and 8 females aged of (56.3±11.6) years in the transfusion-free group;and there were 16 males and 12 females aged (54.3±14.2)years in the allogeneic transfusion group. The transplant recipients who had not adopted transfusion management strategy from January to July 2019 were included as control group(27 males and 13 females,aged of (58.9±14.1)years). The clinical data of patients in perioperative period were collected to compare whether there were differences in the recovery of liver function and early complications among the three groups, one-way ANOVA test, rank-sum test, and χ2 test were used for data analysis. Results: The amount of intraoperative blood loss in both the transfusion-free group and the transfusion group was less than that in the control group((454.2±271.3)ml vs.(673.6±333.4)ml vs.(890.3±346.7)ml;q=-6.342,-5.286,both P<0.05).The duration of stay in ICU of the transfusion-free group was less than that of the transfusion group and control group((36.4±9.1)hours vs.(44.3±14.9)hours vs.(58.2±21.1)hours;q=-4.432,-3.824,both P<0.05).The mean ALT level at 7 days after operation was significantly lower in the transfusion-free group than in the control group((56.8±32.1)U/L vs.(89.6±45.6)U/L;q=-3.358,P<0.05). Conclusions: The improvement of multi-disciplinary transfusion management technology aimed at transfusion-free liver transplantation can effectively reduce intraoperative hemorrhage and help to avoid surgical transfusion. Transfusion-free liver transplantation is beneficial to the early postoperative recovery,and its long-term clinical significance is worthy of further clinical research.

[Nursing work mode in the treatment of massive burn casualties].

Massive burns are catastrophic accidents, usually brings about serious injuries, vast social influence, and great difficulties in treatment. It can impose a big challenge on nursing managers with difficulty in nursing care quality assurance due to a surge of nursing workload within a short period of time and great pressure on nurses. In China, the nursing work mode for dealing with massive burns is to mobilize nursing manpower within the hospital or even outside the hospital by activating the emergency response plan. This mode, however, only ensures the adequacy of nursing staff, but not the professionalism of nursing specialty. In dealing with massive burns, the overseas nursing work mode pays more attentions to scientific transportation of patients, efficient triage, and quality control, which are more systematic and comprehensive. Based on the current status of medical treatment in China and our working experience in the Department of Burn Surgery of the First Affiliated Hospital of Naval Medical University, this article reviewed and discussed the working mode from 2 perspectives, i. e. nursing human resource management and nursing quality control, with an aim to provide a reference for the optimization of the nursing work mode for dealing with mass burns in China.

Protective effect of ulinastatin combined with dexmedetomidine on lung injury after cold ischemia-reperfusion in rats.

OBJECTIVE: We investigated the protective effect of ulinastatin combined with dexmedetomidine on lung injury after hepatic ischemia-reperfusion in rats. MATERIALS AND METHODS: A total of 60 healthy and clean male Sprague Dawley (SD) rats were divided into the blank control group (group O), the model control group (group K), the ulinastatin and dexmedetomidine group (group F) according to random number table with 20 rats in each group. RESULTS: The plasma concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8) and malondialdehyde (MDA) at T1, T2 and T3 time points in rats of the three groups were significantly higher than those of the T0 time point (p<0.05). The superoxide dismutase (SOD) activity in the plasma of rats of the three groups was significantly lower at T1, T2 and T3 time point when compared with that of T0 (p<0.05). The concentrations of TNF-α, IL-6, IL-8 and MDA in group K at T1, T2 and T3 moments were significantly higher than those of group O (p<0.05). However, the concentrations of IL-6, IL-8, TNF-α and MDA in group F at T1, T2, T3 were significantly lower than those of group K (p<0.05). The activities of SOD in group K at T1, T2, T3 were all significantly higher than those of group O (p<0.05). Meanwhile, the activities of SOD in group F at T1, T2, T3 were significantly higher than those of group K (p<0.05). CONCLUSIONS: Ulinastatin combined with dexmedetomidine can reduce the inflammatory response and inhibit lipid peroxidation, eventually alleviating acute lung injury after hepatic ischemia-reperfusion in rats.