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【Objective】 To explore the clinical application effects of animated video in doctor-patient communication before surgical treatment of ureteral calculi. 【Methods】 A total of 278 cases of ureteral calculi treated in our hospital during Jan. and Dec.2021 were selected as subjects. According to the operation periods, 146 patients treated during Jan. and Jun.2021 were classified as the conventional group, who received traditional oral explanation for preoperative conversation, while 132 patients treated during Jul. and Dec.2021 were classified as the video group who watched animated video for preoperative conversation. The two groups of patients and their families were compared in terms of operation awareness, satisfaction of preoperative conversation, anxiety, preoperative ECG monitoring abnormalities, medical complaints and so on. 【Results】 The operation awareness [(93.35±2.33) vs. (89.21±2.78) points] and satisfaction of preoperative conversation [(94.27±2.33) vs. (91.36±3.68) points] of the video group were significantly higher than those of the conventional group (P<0.05). In terms of anxiety, abnormal preoperative ECG monitoring and medical complaints, the video group also had significant advantages (P<0.05). 【Conclusion】 Using animated video to assist preoperative conversation can effectively improve the awareness of patients and their families about the operation, and alleviate the anxiety and fear of patients, so that they are more cooperative. This ensures the smooth operation and reduces the occurrence of postoperative complaints.
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Objective To compare the reliability of intravascular ultrasound (IVUS) and quantitative coronary analysis (QCA) used in coronary intermediate lesion.Methods 90 patients diagnosed as coronary intermediate lesion by coronary angiography were divided into QCA group (n =43) and IVUS group (n =47) according to a random number table method.The QCA group received conventional coronary angiography,while the IVUS group were given intravascular ultrasound.Minimum lumen area,diameter stenosis rate,reference vessel diameter and minimum lumen diameter of the two groups and the correlation between the two methods were compared and analyzed.The treatment plan was made according to the results,and appropriate drug intervention was administered after the treatment.The cardiovascular events in 3,6,9 and 12 months of the two group were also compared.Results The diameter stenosis rate of the QCA group and lumen area stenosis rate in IVUS group showed no correlation (P =0.351),and the minimum lumen area of IVUS group was (4.6 ± 0.68) mm2.The IVUS group were analyzed by both IVUS and QCA methods.The reference vessel diameter of the two groups was positively correlated[(3.16 ±0.22)mm vs.(3.29 ±0.18)mm,r =0.627.,P =0.031],and the minimal lumen diameter of the two groups was also positively associated[(2.01 ± 0.16)mm vs.(2.03 ±0.19)mm,r =0.782,P =0.019].After 1-year follow-up,the incidence rate of cardiovascular event of the QCA group was significantly higher than that of the IVUS group (x2 =4.126,P =0.033).Kaplan-Meier analysis showed that the incidence rate of cardiovascular events in the IVUS group was significantly reduced(Log-rank x2 =4.979,P =0.026).Conclusion The application of IVUS is more comprehensive in qualitative and quantitative analysis of the characteristics of the lesion,and can provide more accurate reference for reasonable treatment plan.
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Objective To investigate the clinical features and pathogenic characteristics of different types of deep sternal wound infection in dif?ferent types after cardiac surgery. Methods A retrospective study was performed. From January 2012 to December 2014,84 patients with sec?ondary DSWI after cardiac surgery underwent the pectoralis major muscle flap transposition in our department were recruited for the study. Re?sults The average age of 84 patients with DSWI was 54.6 ± 14.8 years old,of which typeⅡDSWI patients were the most common(49/84, 58.3%). Both typeⅠand typeⅡDSWI patients showed typical clinical manifestations and early chest X?ray or Computerized tomography(CT) showed mediastinal widening(P0.05),but the pathogenic results of the 3 types of those DSWI patients showed such a trend:typeⅠDSWI patients with GNB is was more common,and typeⅡDSWI patients was more prone to complicated infection. Conclusion Different types of DSWI may dis?play different features,the prevention and treatment of DSWI should be closely combined with the clinical manifestations and local pathogenic char?acteristics.
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<p><b>OBJECTIVE</b>To analyze and summarize the clinical features and experience in surgical treatment of deep sternal infection (DSWI).</p><p><b>METHODS</b>This was a retrospective study. From January 2008 to December 2013, 189 patients with secondary DSWI after cardiac surgery underwent the pectoralis major muscle flap transposition in our department. There were 116 male and 73 female patients. The mean age was (54 ± 21) years, the body mass index was (26. 1 ± 1. 3) kg/m2. The incidence of postoperation DSWI were after isolated coronary artery bypass grafting (CABG) in 93 patients, after other heart surgery plus CABG in 13 patients, after valve surgery in 47 patients, after thoracic aortic surgery in 16 patients, after congenital heart disease in 18 patients, and after cardiac injury in 2 patients. Clean patients' wound and extract secretions, clear the infection thoroughly by surgery and select antibiotics based on susceptibility results, and then repair the wound with appropriate muscle flap, place drain tube with negative pressure. Of all the 189 patients, 184 used isolate pectoralis, 1 used isolate rectus, and 4 used pectoralis plus rectus.</p><p><b>RESULTS</b>The operative wounds of 179 patients were primary healing (94. 7%). Hospital discharge was postponed by 1 week for 7 patients, due to subcutaneous wound infection. Subcutaneous wound infection occurred again in 8 patients 1 week after hospital discharge, and their wounds healed after wound dressing. Nine patients (4. 7%) did not recover, due to residue of the sequestrum and costal chondritis, whom were later cured by undergoing a second treatment of debridement and pectoralis major muscle flap transposition. Eight patients died, in which 2 died of respiratory failure, 2 died of bacterial endocarditis with septicemia, 2 died of renal failure, 1 died of intraoperative bleeding leading to brain death and the 1 died of heart failure. The mortality rate was 4. 2% . The average length of postoperative hospital stay was (14 ± 5) days. The longest postoperative follow-up period was 40 months, the median time was 26 months, the follow-up rate was 83. 9% . Totally 179 patients were no-reinfected, 2 patients were reinfected because of artificial vascular rejection.</p><p><b>CONCLUSION</b>To perform surgical debridement and then reconstruct the sternal defect with pectoralis major muscle flap actively for the patient is an effective measure to improve patient's survival rate.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Cardiac Surgical Procedures , Coronary Artery Bypass , Debridement , Heart Defects, Congenital , Incidence , Length of Stay , Pectoralis Muscles , Transplantation , Postoperative Complications , Postoperative Period , Retrospective Studies , Sternum , General Surgery , Surgical Flaps , Surgical Wound Infection , General Surgery , Wound HealingABSTRACT
Objective To study the value of PSADT in predicting the prognosis and the possibility of disease progression for patients with prostate cancer after MAB therapy.Methods Based on the retrospective review of the history and the follow-up of 159 prostate cancer patients,who received MAB therapy in our department from January 1994 to December 2010,PSADT values were calculated and survival analysis was performed.The ages at diagnosis ranged from 54 to 90 years with a median of 74 years.The pretreatment PSA value ranged from 2.6 to 275.0 μg/L with a median of 46.8 μg/L.The patients of Gleason score ≤6,7 and ≥8 constituted 27.7％,42.1％ and 25.2％,respectively.Only 26.4％ of the patients were staged as T1N0M0-T2N0M0 and the others had locally advanced disease or metastasis.A multivariate analysis with a Cox's proportional hazard model was used and the disease progression rates in different PSADT groups were also compared.Chi-square test and Log-rank test were applied in statistic analysis.Results The 159 patients received follow-up with a median period of 28 months (6-126 m).The median PSADT of these 159 patients was 5.7 months (0.5-21.0 m).The 3-year and 5-year survival for the 71 patients,whose PSADT were not less than 6 months,were 89.4％ and 47.6％ respectively,compared with 49.8％ and 30.6％ for the other 88 patients whose PSADT were less than 6 months.The survivals were significantly different between the two groups (P ＜ 0.01).It was confirmed by a further multivariate analysis with a Cox' s proportional hazard model that PSADT was one of the predictive factors of the prognosis of these prostate cancer patients with a hazard ratio of 2.6 (P ＜ 0.01).Moreover,disease progression were found in 19.7％ of the PSADT≥6 m group during the follow-up compared with 63.6％ in the PSADT ＜6 m group.The disease progression rates were also significantly different (P ＜ 0.0 l).Conclusions PSADT can be used to predict the prognosis of patients with prostate cancer after the MAB therapy.The survival for the patients,whose PSADT are not less than 6 months,is higher than those whose PSADT less than 6 months.Meanwhile,PSADT can predict the possibility of disease progression after MAB treatment.