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Objective:To investigate the role of subcutaneous negative pressure drainage device in the prevention of surgical site infections (SSI) of superficial incisional in lower digestive tract open surgeries.Methods:Clinical data of 104 patients receiving open surgeries on lower digestive tract at Beijing Friendship Hospital, Capital Medical University from October 2018 to June 2020 was analyzed by a propensity score matching (PSM), and the clinical data of 104 patients receiving open surgeries on lower digestive tract at Beijing Friendship Hospital, Capital Medical University from February to December 2021 was analyzed by a randomized controlled trial (RCT). Chi-square tests were conducted to analyze the association of subcutaneous negative pressure drainage device with SSI of superficial incisional. Univariate and multivariate Logistic regression analysis were used to identify the risk factors for SSI in superficial incisions.Results:Patients with subcutaneous negative pressure drainage device encounter significantly less SSI of superficial incisional in both the PSM study ( P=0.007) and the RCT study ( P=0.049). In the PSM study, the independent risk factors for SSI of superficial incisional via univariate and multivariate Logistic regression analysis were absence of subcutaneous drainage ( Puni=0.012, Pmulti=0.009) and postoperative anastomosis leak ( Puni=0.054, Pmulti=0.034). In the RCT study, the independent risk factors for SSI of superficial incisional via univariate and multivariate Logistic regression analysis were absence of subcutaneous drainage ( Puni=0.061, Pmulti=0.017), eldly ( Puni=0.076, Pmulti=0.032), long incision ( Puni=0.078, Pmulti=0.040). Conclusion:Subcutaneous negative pressure drainage device can significantly reduce SSI of superficial incisional in lower digestive tract open surgeries.
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Objective To compare the clinical effect and safety of transcatheter arterial chemoembolization (TACE) combined with 125I seed implantation with those of pure TACE in treating primary liver cancer (PHC) complicated by portal vein tumor thrombus (PVTT) . Methods Computer and manual retrieval of PubMed, Cochrane Library, CBM, Wan Fang Database, China National Knowledge Internet and other databases was conducted to collect the retrospective cohort studies on the comparison of the clinical effect and safety of the combination use of TACE and 125I seed implantation with those of simple TACE in treating PHC complicated by PVTT, from which the relevant data were extracted. The quality of extracted documents was assessed according to the standard of Cochrane manual. Results A total of eight articles containing 822 patients were included in this study. Meta analysis indicated that both the effective rate and disease control rate for PHC complicated by PVTT in TACE plus 125I seed implantation group were significantly higher than those in pure TACE group, and the differences between the two groups were statistically significant (P<0.05) . The half-year, one-year and 2-year survival rates of TACE plus 125I seed implantation group were better than those of pure TACE group, and the differences between the two groups were statistically significant (P<0.05) . No statistically significant differences in the incidence of severe complications existed between the two groups (P>0.05) . Conclusion In treating PHC complicated by PVTT, the curative effect of TACE plus 125I seed implantation is superior to pure TACE. No obvious difference in the incidence of severe complications exists between the two groups.
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Objective To explore the endovascular treatment of Budd-Chiari syndrome (BCS) in young child. Methods The clinical data of one young child diagnosed with BCS and treated with endovascular therapy were retrospectively analyzed. Results The 23-month-old female suffered from repeated abdominal distension for 3 months and was diagnosed with BCS by vascular ultrasound Doppler and magnetic resonance examination. After confirmation of the diagnosis, endovascular treatment was performed. Then the occluded blood vessels resumed blood stream, urine output increased, and abdominal distension was significant relieved. Conclusions In young children, BCS is rare, the condition is complex, and endovascular therapy is effective.
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Objective To explore the clinical application of 3D-printing model in guiding interventional management of Budd-Chiari syndrome (BCS) and in teaching practice.Methods A patient with typical BCS of inferior vena cava type was selected.By using MR enhanced scanning,the original MRA data of DICOM format were extracted,and then the digital data were extracted and reconstructed to obtain 3D BCS model by Simpleware software.The 3D BCS entity model,using 1 ∶ 1 ratio,was printed out by a 3D printer.An experienced chief physician made a simulated interventional manipulation on this 3D BCS entity model.Results The BCS 3D model was successfully printed.Simulated operation could be easily performed on the 3D-printing model,in this way the chief physician could make a demonstration of interventional procedure of BCS to the junior doctors and medical students.Interventional therapeutic manipulation for BCS could be well demonstrated on the 3D-printing model of BCS,which was very helpful in guiding teaching practice and in promoting the communication between doctors and patients.Conclusion The BCS 3D-printing model can truly reflect the spatial architecture features of the inferior vena cava and the hepatic veins,which are very valuable for the making of surgical plan,for the demonstration of simulation operation,and for teaching practice.Moreover,3D-printing model can stereoscopically display the location and morphology of the lesion,which can improve patient's understanding of the disease,thus,the communication between doctors and patients can be strengthened.
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Objective To establish a three-dimensional (3D) model of the diaphragm type of Budd-Chiari syndrome (BCS) with perforated membrane,to analyze changes of hemodynamic parameters pre and post percutaneous transluminal angioplasty (PTA) and to analyze any possibly related mechanical factors for postoperative recurrence in BCS.Methods The data on enhanced MRI from patients suffering from BCS with perforated diaphragm of inferior vena cava were reconstructed into a 3D model Computational fluid dynamics (CFD) were applied for numerical simulation based on the model,and the results were expressed as cloud images.Results The total number of model units of the finite element model for preoperative inferior vena cava stenosis was 16 422,and the total number of nodes was 48 170.The total number of model units for postoperative inferior vena cava was 16 539,and the total number of nodes was 51 339.Hemodynamic patterns of the lesion areas were effectively reflected in the 3D flow dynamic model for BCS.By comparing the hemodynamic parameters before and after interventional therapy,the data indicated that there was a gradual decline in wall pressure from the telecentric side.The largest blood flow velocity as well as wall shear stress were observed in the stenotic area of inferior vena cava.Both a large postoperative vascular central velocity and a low increase in local pressure predicted occurrence of vascular restenosis.Conclusions The establishment of a 3D fluid model of inferior vena cava revealed that there were mechanical changes in the location of the lesion.Variations in blood flow patterns exert a far-reaching influence on distribution of hemodynamic parameters,including local blood flow velocity,vascular wall pressure and shear stress.All these might be related to recurrence of BCS after interventional therapy.
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Objective To study the effects of exercise on hemodynamic parameters and cardiovascular humoral factors in the elderly patients with hypertension. Methods The modified Bruce assessment (MBA) was employed in an essential hypertension (EH) group (group 1, n =34) composed by elderly EH patients and a control group (group 2, n =31) composed of normal subjects. Heart rate (HR),systolic and diastolic blood pressure (SBP、DBP), and the quantum and duration of exercise (QE, DE) were explored, while the serum concentrations of nitric oxide (NO), endothelin 1(ET1), atrial natriuretic factor (ANF) and AngiotensinⅡ(AngⅡ) were measured at 3 min before and after treatment. Results There were no significant differences between groups 1 and 2 with regard to HR, SBP, DBP, total DE and peak QE before and after treatment, in addition, at the peak of exercise ( P 0.05). Pretreatment SBP and DBP were significantly and positively correlated with those at the peak of and after treatment ( r =0.648,0.630, P