High-dose (HD) tigecycline is often required for severe multidrug-resistant gram-negative infections in liver failure patients, despite package recommendations to halve the dose for those with severe liver impairment. This study evaluated the efficacy and safety of different tigecycline doses in this population. A retrospective cohort of 192 patients with Child-Pugh grade C liver failure was divided into label-dose (LD), standard-dose (SD), and HD groups. Primary and secondary outcomes included microbial eradication, mortality, and adverse effects. The SD group achieved higher microbial eradication than LD, with comparable efficacy to HD but fewer adverse events, such as fibrinogen requirements. High-dose treatment increased mortality risk (Hazard Ratio: 1.85, p = 0.062). Optimal microbial eradication and minimized adverse effects occurred with the SD group at 7 days of treatment. Standard-dose tigecycline offers a balanced approach to microbial eradication and safety, making it preferable in liver failure patients.
BACKGROUND Pulmonary rehabilitation is a crucial part of the nonpharmacological treatment of stable chronic obstructive pulmonary disease (COPD), but management remains problematic. WeChat could serve as a useful tool in patient management. Baduanjin is a popular exercise in China that is usually applied in pulmonary rehabilitation, which has been confirmed to be effective in improving lung function and life quality. OBJECTIVE This study aimed to explore the efficiency of WeChat in the management of Baduanjin exercise in COPD patients. METHODS A total of 200 patients from the respiratory department of Putuo Hospital participated in the Baduanjin rehabilitation project from September 2018 to October 2019, and were randomly assigned to the WeChat and control groups and followed up using the WeChat platform or telephone for 12 weeks. The frequency of Baduanjin exercise, lung function (percentage of forced expiratory volume in 1 second predicted, FEV1% predicted), and COPD assessment test (CAT) scores were collected and compared between the two groups. The number of message exchanges and a satisfaction survey on the WeChat platform were used to assess the feasibility of WeChat management outside the hospital. RESULTS The Baduanjin exercise frequency significantly differed between the control group and WeChat group (<i>F</i>=33.82, <i>P<</i>.001) and across various time points (<i>F</i>=214.87, <i>P<</i>.001). After the follow-up on WeChat, there were fewer patients not performing Baduanjin exercise. The FEV1% predicted value significantly differed before and after Baduanjin exercise in the control group (<i>Z</i>=−3.686, <i>P</i><.001) and the WeChat group (<i>Z</i>=−6.985, <i>P<</i>.001). A significant difference in the FEV1% predicted value was observed after Baduanjin exercise between the two groups (<i>Z</i>=−3.679, <i>P</i><.001). The CAT score significantly differed before and after Baduanjin exercise in the control group (<i>Z</i>=−4.937, <i>P<</i>.001) and the WeChat group (<i>Z</i>=−5.246, <i>P</i><.001). A significant difference in the CAT score was observed after Baduanjin exercise between the two groups (<i>Z</i>=−5.246, <i>P<</i>.001). The number of completed Baduanjin exercises, lung function, and CAT scores in active patients were higher than those in nonactive patients. All satisfaction survey items were scored with more than 4 points. Among the items, the highest score (mean 4.54, SD 0.77) was for continued WeChat management, followed by the effective management of Baduanjin exercise (mean 4.46, SD 0.87). The patients in the WeChat group showed much higher enthusiasm for and compliance with Baduanjin exercise, resulting in better life quality and lung function. The patients were very satisfied with the WeChat management because of the obvious curative effect and home feeling. CONCLUSIONS The WeChat platform provided a feasible, effective, and sustainable management plan for Baduanjin rehabilitation. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR1900028248; http://www.chictr.org.cn/showprojen.aspx?proj=46995
To observe the changes of brain oxygen metabolism and neuroelectrophysiology after severe brain injury, and the effects of hypothermia on severe brain injury.148 patients with severe brain injury (GCS 3 - 8, admitted within 10 hours from injury) were selected for this study. Patients were divided into 3 groups, Group GCS 7 - 8, Group GCS 5 - 6 and Group GCS 3 - 4. Every group were also randomly assigned to normothermia and hypothermia subgroup. Patients in the hypothermia group were cooled to 32 approximately 34 degrees C. SLSEP, BAEP, P(br)O(2) and rSaO(2) were recorded in each group at the same time.In the Group GCS 7 - 8, N20 in SLSEP, I/V in BAEP and rSaO(2) were improved significantly after mild hypothermia treatment, and P(br)O(2) was decreased by hypothermia; In the Group GCS 5 - 6, N20 in SLSEP, I/V in BAEP and rSaO(2) were improved by hypothermia, and P(br)O(2) was decreased in hypothermia subgroup; In the Group GCS 3 - 4, no significant difference was found.Mild hypothermia has a significant effect on patients of GCS 7 - 8 and a doubt effect on patients of GCS 5 - 6. It seem no effect on patients of GCS 3 - 4. Brain oxygen metabolism and neuroelectrophysiology are important to value the therapeutic effect on severe brain injury.
Purpose to investigate preventive measures of rectal stricture after procedure for prolapse and hemorrhoids (PPH) and to intervene early. Methods A total of 400 patients with severe mixed hemorrhoids hospitalized in the [anonymous hospital] from January 2018 to February 2022 were randomly divided into the experimental group and control group A, B, and C, with 100 patients in each group. Experimental group: Thread-drawing during operation and anal enlargement after PPH. Group A: Thread-drawing during PPH surgery, group B: Anal enlargement after PPH, and group C: PPH alone. The anastomotic sites of the 4 groups were observed for 1-2 months and followed up for 1-3 years. Results The effective rate of mixed hemorrhoid treatment in the 4 groups was 100%. There was no rectal stenosis in the experimental group, 11% in group A, 7% in group B, and 14% in group C. Conclusion Multipoint thread-drawing and anal enlargement after PPH can avoid postoperative rectal stenosis and can strengthen anastomosis and reduce bleeding, while being a simple procedure that can be easily popularized.
Abstract: Procedure for Prolapse and Hemorrhoids (PPH), also known as circular stapled hemorrhoidectomy, is a common method of treating hemorrhoids due to its low risk of complications and minimal postoperative pain. Several complications have appeared alongside the rise of treated cases, however, and this has led to a progressive slowing of the clinical use of PPH in recent years. Anastomotic stenosis is one of the most common complications of PPH, but the greater amount of tissue removed and the speed with which it can heal make it the best choice for patients with severe prolapsed annular hemorrhoids or rectal mucosal prolapse. Therefore, academics continue to comprehensively study PPH to take advantage of annular resection and reduce complications. In this paper, we analyzed the causes, intraoperative warnings, and postoperative therapy of anastomotic stenosis induced by PPH, with an eye toward scientific application in the anorectal field, based on the experience of clinical applications. Keywords: anastomotic stricture, hemorrhoid, prevention, treatment
Objective:To reveal the effects of different doses of naloxone on moderate and severe acute head injuries by monitoring of qEEG.Methods:86 patients with moderate and severe acute head injuries (Glasgow Coma Scale 3～12,within 12 hours after injury) were selected for this study.According to the severity of injury,all patients were classified into three groups: GCS3～5,GCS6～8 and GCS9～12.Patients of each group were then randomly assigned to treatment with naloxone or control.In naloxone groups,low doses of naloxone and high doses of naloxone were administered respectively to the patients with acute brain injury of different severity for three days.Relative power of δ frequency and absolute power of 1～25 frequency were monitored with qEEG before and 30 minutes,1,2,24,48,72,120 hours after administration.Results:In GCS 9 to 12 group,relative power of δ frequency and absolute power of 1～25 frequency were significanfly different ( P 0.05) in qEEG between naloxone groups and control group,while there was no significant difference of all parameters between low dose and high dose naloxone groups( P 0.05).In GCS 6 to 8 group,the two parameters were improved significanfly in naloxone groups and were significantly different between low dose and high dose naloxone groups.In GCS 3 to 5 group,all parameters were not significantly different between naloxone group and control group.Conclusion:These results suggest that treatment with naloxone in patients with moderate and severe head injuries is beneficial in terms of improved qEEG and there is no significant difference between low dose and high dose naloxone in GCS 9 to 12 group,but in GCS 6 to 8 group high dose naloxone shows better efficacy than low dose naloxone.
Pulmonary rehabilitation is a crucial part of the nonpharmacological treatment of stable chronic obstructive pulmonary disease (COPD), but management remains problematic. WeChat could serve as a useful tool in patient management. Baduanjin is a popular exercise in China that is usually applied in pulmonary rehabilitation, which has been confirmed to be effective in improving lung function and life quality.This study aimed to explore the efficiency of WeChat in the management of Baduanjin exercise in COPD patients.A total of 200 patients from the respiratory department of Putuo Hospital participated in the Baduanjin rehabilitation project from September 2018 to October 2019, and were randomly assigned to the WeChat and control groups and followed up using the WeChat platform or telephone for 12 weeks. The frequency of Baduanjin exercise, lung function (percentage of forced expiratory volume in 1 second predicted, FEV1% predicted), and COPD assessment test (CAT) scores were collected and compared between the two groups. The number of message exchanges and a satisfaction survey on the WeChat platform were used to assess the feasibility of WeChat management outside the hospital.The Baduanjin exercise frequency significantly differed between the control group and WeChat group (F=33.82, P<.001) and across various time points (F=214.87, P<.001). After the follow-up on WeChat, there were fewer patients not performing Baduanjin exercise. The FEV1% predicted value significantly differed before and after Baduanjin exercise in the control group (Z=-3.686, P<.001) and the WeChat group (Z=-6.985, P<.001). A significant difference in the FEV1% predicted value was observed after Baduanjin exercise between the two groups (Z=-3.679, P<.001). The CAT score significantly differed before and after Baduanjin exercise in the control group (Z=-4.937, P<.001) and the WeChat group (Z=-5.246, P<.001). A significant difference in the CAT score was observed after Baduanjin exercise between the two groups (Z=-5.246, P<.001). The number of completed Baduanjin exercises, lung function, and CAT scores in active patients were higher than those in nonactive patients. All satisfaction survey items were scored with more than 4 points. Among the items, the highest score (mean 4.54, SD 0.77) was for continued WeChat management, followed by the effective management of Baduanjin exercise (mean 4.46, SD 0.87). The patients in the WeChat group showed much higher enthusiasm for and compliance with Baduanjin exercise, resulting in better life quality and lung function. The patients were very satisfied with the WeChat management because of the obvious curative effect and home feeling.The WeChat platform provided a feasible, effective, and sustainable management plan for Baduanjin rehabilitation.Chinese Clinical Trial Registry ChiCTR1900028248; http://www.chictr.org.cn/showprojen.aspx?proj=46995.
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