Abstract Background Upper gastrointestinal bleeding (UGIB) is common in liver cirrhosis. Although esophageal and gastric varices (EGV) is the main bleeding source, there were still a proportion of patients with peptic ulcer bleeding, which has been easily neglected. Thus, this study aimed to analyzed and compared the characteristic of variceal bleeding and peptic ulcer bleeding in liver cirrhosis patients. Methods Cirrhotic patients with confirmed UGIB by urgent endoscopy from July 2012 to June 2018 in our hospital were enrolled, and classified into peptic ulcer bleeding group (n=248) and variceal bleeding group (n=402) based on the bleeding cause. The clinical and endoscopic characteristics, therapeutic efficacy and prognosis were evaluated and compared, and independent risk factors for 42-day morality in peptic ulcer bleeding in cirrhotic EGV patients were determined. Results Compared with variceal bleeding group, peptic ulcer bleeding group were older (55.58±11.37 vs. 52.87±11.57, P<0.01) and more stable, and the most common symptom was melena. Hepatocellular carcinoma was more prevalent in peptic ulcer group (141 vs. 119, P<0.01). The success rate of endoscopic hemostasis for variceal bleeding and peptic ulcer bleeding was 89.05% and 94.35%, respectively (P=0.021). Univariate and multivariate analysis identified emergency intervention (P=0.018, OR [95% CI] 11.270 [1.503-84.501]), hepatic encephalopathy before bleeding (P=0.034, OR [95% CI] 6.831 [1.159-40.255]) and hepatic renal syndrome before bleeding (P=0.013, OR [95% CI] 8.482 [1.568-45.869]) as three independent predictors for 42-day mortality. Conclusion Peptic ulcer bleeding should be distinguished from variceal bleeding by clinical and endoscopic characteristics, and urgent endoscopic treatment is needed once diagnosed.
To evaluate the value of application of extracardiac conduit total cavopulmonary anastomosis (TCPA) in complex heart disease.From June 1998 to August 1999, 10 patients with functional univentricular complex congenital heart diseases received TCPA. Eight patients were male and 2 female with a mean age of (9.0 +/- 5.6) years (from 2.5 to 21 years) and a mean weight of (25 +/- 14) kg (from 11 to 45 kg). Associated heart anomalies were TGA, PS or ASD. All surgical procedures were performed under general anesthesia and hypothermia.No operative and postoperative deaths and all patients were followed up for 6 - 18 months. All patients were clinically asymptomatic. There was no increase of systemic venous pressure. EKG revealed no arrhythmias. The cardiac function was in NYHA class I-II.Extracardiac conduit TCPA is a simple procedure and it is superior to others.
To evaluate the early and mid-term results of pulmonary trunk reconstruction using a technique in which autogenous tissue is preserved in situ in pulmonary atresia patients with a ventricular septal defect (PA-VSD).The pulmonary artery was reconstructed using autogenous tissue that had been preserved in situ and a bovine jugular venous patch in 24 patients who were diagnosed with PA-VSD (the observation group). The traditional operation using a bovine jugular venous conduit was performed in 40 other cases of PA-VSD (the control group).In the observation group, all patients survived and recovered successfully without complications. Follow-up echocardiography 2-10 years after the procedure showed that the reconstructed right ventricular outflow tract (RVOT) and pulmonary artery were patent, showing no evidence of flow obstruction. Only mild regurgitation of the bovine jugular vein valve was observed. In the control group, early postoperative death occurred in two cases. Another two patients had obstruction of the anastomotic stoma and underwent conduit replacement surgery within 2 weeks of the initial procedure. During the 2-10 years of follow-up care, six patients presented with valvular stenosis of the BJVC, with a pressure gradient of more than 50 mmHg.The technique for preserving autogenous tissue to reconstruct the pulmonary posterior wall is a satisfactory method for treating PA-VSD.
To determine the dynamic changes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in respiratory and fecal specimens in children with coronavirus disease 2019 (COVID-19).
Introduction Gut motility dysfunction, the most common complication of post-septic organ dysfunction, depends on immune and neuronal cells. This study aimed to investigate the mechanisms that activate these cells and the contribution of macrophages to the recovery of intestinal motility dysfunction after sepsis. Materials and methods Postoperative gut motility dysfunction was induced by establishing Klebsiella pneumonia sepsis in mice with selective deletion of neutrophils and macrophages in the gut. The distribution of orally administered fluorescein isothiocyanate-dextran and carmine excretion time was used to determine the severity of small bowel disease. The effect of macrophages on intestinal motility was evaluated after prostaglandin E2 therapy. Results We found that muscular neutrophil infiltration leading to neuronal loss in the intestine muscle triggered intestinal motility dysfunction after pneumonia sepsis; however, reduced neutrophil infiltration did not improve intestinal motility dysfunction. Moreover, macrophage depletion aggravated gut motility dysfunction. The addition of macrophages directly to a smooth muscle was responsible for the recovery of intestinal motility. Conclusion Our results suggest that a direct interaction between macrophages and smooth muscle is neurologically independent of the restoration of intestinal dysmotility.
To compare the efficacy between micro invasive occlusion procedure and extracorporeal circulation procedure for treating patients with simple ventricular septal defect.Two hundred and twenty patients with simple ventricular septal defect (except subarterial ventricular septal defect) were randomly divided into micro invasive group (n = 116) and traditional cardiopulmonary bypass surgery group (n = 104). Clinical data were collected and compared at baseline and at 3, 30 and 180 days after surgery.Age, gender, body weight and ventricular septal defect type were similar between the two groups (all P > 0.05). Operation time and hospitalization duration were significantly shorter in the micro invasive group than the traditional cardiopulmonary bypass surgery group (all P < 0.05). The proportion of blood transfusion was less in micro invasive group than the traditional cardiopulmonary bypass surgery group [2.59% (3/116) vs. 72.12% (75/104), P < 0.01]. Three days after surgery, incidence of mild and above tricuspid insufficiency was less in micro invasive group than the traditional cardiopulmonary bypass surgery group [0.86% (1/116) vs. 2.88% (3/104), P < 0.05]. There was one patient developed mild pericardial effusion at 30 days post surgery in micro invasive group. There was no intracardiac infection in the two groups during follow-up. At 30 and 180 days post surgery, incidence of residual shunt was also less in micro invasive group than the traditional cardiopulmonary bypass surgery group [1.72% (2/116) vs. 7.69 (8/104) and 0(0/116) vs. 7.69(8/104), all P < 0.05]. After surgery for 3, 30 and 180 days, transthoracic echocardiography derived chamber size, left ventricular end-diastolic volume index and left ventricular ejection fraction were similar between the two groups (all P > 0.05).The efficacy is similar for patients with simple ventricular septal defect (except subarterial ventricular septal defect) using micro invasive occlusion therapy or extracorporeal circulation surgery. Micro invasive occlusion procedure can shorten operation and hospitalization time, and reduce the need for blood transfusion and risk of developing procedural-related tricuspid insufficiency and post-procedural residual shunt.
To evaluate the nursing model and its effect in patients with an intrauterine pregnancy (IUP) complicated with ovarian torsion after in vitro fertilisation-embryo transfer. The clinical data of 5 patients who were diagnosed as intrauterine pregnancy complicated with ovarian torsion from January 2017 to January 2018 were retrospectively analysed. The ovarian volume, ovarian blood flow and ascites were routinely assessed using ultrasound when admission. Predictive nursing measures, including restoring the ovarian by adjusting the patients' body position, psychological counseling, prevention and treatment of ovarian hyperstimulation syndrome, monitoring the vital signs and painess, providing a quiet and clean room for patients, would be implemented according to the patients' body weight and the abdominal circumference. For the patients who received laparoscopy for restoring or resecting the ovaries, strengthened perioperative care was needed, which included asking the patients to lie flat without pillow for 6 hours, using an abdominal bandage for fixation and protection, close observation of the patients' condition as well as the embryonic development, preventive using of the contraction inhibitor (eg. phloroglucinol) and paying attetion to the side effects of drug, preventing infections, and giving proper life and dietary guidance. All the 5 patients were cured by surgical restoring combined with predictive nursing measures. No nosocomial infections occurred during the period of treatment. All IUPs developed well and lead to live births: 2 cases received Caesarean section and 3 cases gave natural deliveries. There were 4 cases with full-term births, and 1 case of premature delivery. The predictive nursing model can effectively prevent nosocomial infections. reduce patients' sufferings and improve patients' satisfaction. And thus, it is an effective measure to ensure the recovery of the ovarian torsion in patients with an intrauterine pregnancy. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Coronary artery bypass grafting (CABG) operations were performed in 110 consecutive patients. Most of them had extensive triple-vessel disease or left main coronary artery disease. Internal mammary artery (IMA) was used as a graft in 65 patients. Valvular replacement or valvuloplasty were performed in 8 patients and ventricular aneurysmectomy in 10 patients including post infarction VSD repaired in 1 patient simultaneously. Angina pectoris was relieved in all patients except one died from acute renal failure postoperatively. The IMA could be used safely and efficiently in nearly all patients. Using very fine technique, we suggested good exposure, and hemostasis to handle IMA. The key factor of success in CABG operation was complete revascularization by passing all significant stenosis larger than 1 mm diameter in all coronary artery branches.
Introduction: This meta-analysis assessed the predictors of symptomatic intracranial hemorrhage (sICH) after endovascular thrombectomy (EVT) for patients with acute ischemic stroke. Methods: PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science were searched for studies published from inception to February 16, 2021. We included studies that evaluated the predictors of sICH after EVT. The random-effect model or fixed-effect model was used to pool the estimates according to the heterogeneity. Results: A total of 25 cohort studies, involving 15,324 patients, were included in this meta-analysis. The total incidence of sICH was 6.72 percent. Age (MD = 2.57, 95% CI: 1.53–3.61; p < 0.00001), higher initial NIHSS score (MD = 1.71, 95% CI: 1.35–2.08, p < 0.00001), higher initial systolic blood pressure (MD = 7.40, 95% CI: 5.11–9.69, p < 0.00001), diabetes mellitus (OR = 1.36, 95% CI: 1.10–1.69, p = 0.005), poor collaterals (OR = 3.26, 95% CI: 2.35–4.51; p < 0.0001), internal carotid artery occlusion (OR = 1.55, 95% CI: 1.26–1.90; p < 0.0001), longer procedure time (MD = 18.92, 95% CI: 11.49–26.35; p < 0.0001), and passes of retriever >3 (OR = 3.39, 95% CI: 2.45–4.71; p < 0.0001) were predictors of sICH, while modified thrombolysis in cerebral infarction score ≥2b (OR = 0.61, 95% CI: 0.46–0.79; p = 0.0002) was associated with a decreased risk of sICH. There were no significant differences in the female gender, initial serum glucose, initial ASPECT score, atrial fibrillation, oral anticoagulants, antiplatelet therapy, intravenous thrombolysis, general anesthesia, neutrophil-to-lymphocyte ratio, and emergent stenting. Conclusions: This study identified many predictors of sICH. Some of the results lack robust evidence given the limitations of the study. Therefore, larger cohort studies are needed to confirm these predictors.
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