Introduction: Hirschsprung's disease is a common digestive tract malformation in children, and the Soave procedure is one of the classic surgical methods for Hirschsprung's disease (HD). Fecal incontinence is one of the most common postoperative complications that can cause significant distress to the patients and their family, the incidence of which is 20% in a recent series. Biofeedback therapy (BFT) can be an effective treatment for managing anorectal disorders, but there has been little report of the efficacy of BFT for the treatment of fecal incontinence after the Soave procedure, and the main objective of this study is to evaluate it. Methods: We retrospectively analyzed postoperative fecal incontinence in 46 children who received the Soave procedure for HD and who received BFT at our institution from March 2016 to February 2020, which included 38 males and 8 females (mean age 8.1 years, from 3.7 to 14 years). Anal sphincter contraction training was performed using BFT for 10 days per session in the hospital, one time each day, and 20 min each time. BFT was performed by employing visual and verbal feedback techniques using the biofeedback instrument. Long-term functional outcomes were objectively assessed using the Rintala Bowel Function Score (RBFS), and the patients were scored according to the sum total as excellent (18–20 points, 0 case), good (11–16 points, 0 case), fair (9–11 points, 9 cases), or poor (6–9 points, 37 cases). Defecation questionnaires and anorectal manometry were completed pretreatment and after three, six, or nine sessions, and primary outcome measures of anorectal manometry were anal maximal contraction pressure (AMCP), anal longest contraction time (ALCT), rectal rest pressure (RRP), and anal rest pressure (ARP). Results: Followed up from 6 months to 4 years, the symptoms of fecal incontinence disappeared completely in 39 (84.78%) patients. Among them, 14 (30.43%) had complete disappearance of symptoms after 3 sessions of treatment, 25 (54.34%) patients had improved symptoms after 6 sessions of treatment, symptoms completely disappeared after 6 sessions of treatment, and 7 (15.22%) cases still suffered fecal incontinence mildly. The AMCP after three and six sessions in the poor group was significantly increased compared with that before treatment [(85.87 ± 31.75) mmHg vs. (135.33 ± 37.69) mmHg vs. (128.41 ± 33.45) mmHg, P < 0.05]. The ALCT and ARP showed the same trend, while the RRP after three and six sessions were not significant ( P > 0.05). The mean (±SD) score of the RBFS increased from 9 to 17.40 ± 0.84 in the fair group, while it increased from 7.22 ± 0.76 to 16.58 ± 1.66 in the poor group after six sessions ( P < 0.05). Conclusion: Biofeedback therapy is a safe and effective treatment of fecal incontinence after the Soave procedure of children for Hirschsprung's disease. It is beneficial to design the individualized treatment programs for the children with varying degrees of fecal incontinence.
Abstract Background Prone position (PP) ventilation has become an effective and simple treatment for acute respiratory distress syndrome (ARDS) due to COVID-19; however, prolonged prone position not only leads to patient discomfort, but also reduces patient compliance, and is prone to causing adverse events such as pressure injuries, pain, and dizziness. We aim to explore the effects of modular new prone positioning tools in patients with ARDS due to COVID-19. Methods 168 patients with ARDS due to COVID-19 were selected; however, 92 were later disqualified. 76 patients were randomly assigned to the observation group (n = 38) and the control group (n = 38). The observation group used modular new prone positioning tools to implement prone ventilation therapy while the control group used soft pillows to implement prone ventilation therapy. Comfort indicators (including time spent implementing PP, duration of PP, number of postural adjustments during PP, and duration time when first needing to adjust position), adverse events (including artificial airway kinking, shortness of breath, dizziness, and stress injury), and efficacy indicators (including intubation and mortality) were collected. The feeling of comfort, the occurrence of adverse events, and the efficacy of two groups of patients were also evaluated. Results The observation group had shorter time spent implementing PP(2.74 ± 0.86 vs. 4.64 ± 1.02, P < 0.001), longer duration of PP (14.02 ± 1.01 vs. 13.03 ± 0.66, P < 0.001), duration time when first needing to adjust position (59.89 ± 12.73 vs. 36.57 ± 8.69, P < 0.001), and lower number of postural adjustments during PP (11.03 ± 2.67 vs. 17.95 ± 2.58, P < 0.001) in comparison with the control group. No significant differences in intubation (9 vs. 11, P = 0.602) and mortality (4 vs. 6, P = 0.602) were found in both groups. However, in terms of adverse events, the observation group showed lower artificial airway kinking (5 vs. 23, P < 0.001), pain (7 vs. 21, P = 0.001), shortness of breath (2 vs. 9, P = 0.022), dizziness (0 vs. 5, P = 0.021), and stress injury (7 vs. 26, P < 0.001) than the control group. Conclusion Utilizing modular new prone position tools to implement prone ventilation therapy not only improves the efficiency of prone position execution and patient comfort, but also reduces the incidence of adverse events. However, it cannot change the intubation rate and mortality rate of patients.
To explore the effect of comprehensive nursing intervention on rehabilitation of patients after total hip arthroplasty. 100 patients with femoral neck fracture underwent total hip replacement from May 2017 to March 2018. According to the random number method, 50 patients in each group were divided into observation group and control group. The control group was given postoperative routine nursing, the observation group was treated with comprehensive nursing intervention, and the two groups were treated with Minnesota Heart failure quality of Life questionnaire (MLHFQ) before nursing. The effect of nursing intervention and the influence on limb function were compared between the two groups. Results 1 month after operation, 3 patients in the observation group The Harris score of the observation group was higher than that of the control group (P < 0. 05), and the Barthel index of the observation group was higher than that of the control group (P < 0. 05). The comprehensive nursing intervention for the patients with femoral neck fracture undergoing hip arthroplasty has positive effect on the early recovery of the patients.
To investigate the effect of acupuncture and moxibustion on functional recovery after knee arthroplasty. One hundred cases of knee arthroplasty were performed in the PLA's 371th Hospital of the PLA from February 1, 2017 to March 22, 2018. Random divided into observation group and control group, each group of 50 cases, observation group on the basis of postoperative routine nursing acupuncture treatment; In the control group of 50 patients, routine postoperative care was given to evaluate the knee function of the two groups of patients and the values of aLDFA and aMFTA in the direction of the distal femoral axis. HSS knee function score was significantly improved in two groups (P<0.05), The HSS knee function score was better than that of the control group (P<0.05). The observation group aLDFA and aMFTA were superior to the control group (P<0.05). The difference is statistically significant. Acupuncture and moxibustion can promote the recovery of knee joint after replacement, which is beneficial to the rehabilitation of patients.
To select the optimized treatment plan of acupuncture for lateral femoral cutaneous neuritis by using multiple indexes decision-making method based on the clinical evidence.The randomized control trials (RCTs) regarding acupuncture for lateral femoral cutaneous neuritis in the CNKI database, CBM database, WANFANG database, VIP database, PubMed, Cochrane Library and Embase published before December 31, 2017 were comprehensively collected. The modified Jadad scale was used to evaluate the quality of the RCTs. Then the evaluation indexes were selected and the dimensions of evaluation indexes were standardized by using extreme difference transformation method. The weight of each index was determined by using relative comparison method and the standardized matrix was weighted. Thus, the ideal solution and the negative ideal solution were obtained, and the relatively degree of each treatment plan to the ideal solution was calculated to propose the optimized plan of acupuncture for lateral femoral cutaneous neuritis.A total of 18 RCTs were included, the optimized plan of acupuncture for lateral femoral cutaneous neuritis was using thin fire needle to rapidly prick the abnormal skin region with fast needle insertion-withdrawal technique; the fire needle was applied repeatedly; intensive pricking to form a treatment area; the treatment was given once every 5 days.Based on the current clinical evidence, the optimized plan of acupuncture for lateral femoral cutaneous neuritis is using thin fire needle to prick the abnormal skin region; the multiple methods of plum-blossom needling met the characteristic of lateral femoral cutaneous neuritis and is suitable for clinical selection. The main acupoints are ashi points in the abnormal skin area or the acupoints in the foot-yangming meridian and foot-shaoyang meridian, combined with lumbar Jiaji (EX-B2) points.
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