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Nurse-led coaching of shared decision-making for wound treatment of pressure injury: A pilot study of a randomized trial. 护士主导的共同决策指导伤口治疗压力损伤:一项随机试验的初步研究。
IF 1.5 Q2 Medicine Pub Date : 2023-07-01 DOI: 10.4103/tcmj.tcmj_256_22
Mei-Yu Hsu, Yu-Sin Chen, Ying-Chun Chen, Yu-Lin Wu

Objectives: International guidelines for managing pressure injury (PI) and ulcers recommend that family members and caregivers should be involved in making decisions for appropriate wound care. However, the effect of shared decision-making (SDM) in the context of PI remains unknown. This study investigated the efficacy of nurse-led medical SDM for PI treatment.

Materials and methods: We constructed a patient decision aid (PDA) for PI treatment on the basis of nursing evidence. Subsequently, we conducted a pilot randomized controlled trial to evaluate the efficacy of SDM compared with that of usual care (control group, [CG]) for PI treatment. Participants with stage 3, stage 4, or unstageable PI were included and randomized into two groups. In the SDM group (SDMG), 10 participants received the SDM intervention for PI before treatment. All participants were followed up for 4 weeks. Primary outcomes were measured using the nine-item SDM Questionnaire (SDM-Q-9) and Decisional Conflict Scale (DCS). Secondary outcomes included wound size and cost of wound management.

Results: The expert validity (medical professors and general population) of the PDA designed for PI was measured, and the content validity index was 0.96-0.97. A total of 20 participants were enrolled (10 received SDM and 10 received usual care). The mean age of the participants was 55.7 ± 8.8 years. No significant difference in baseline characteristics (sex, age, staging, or wound area) was observed between the two groups. The SDMG had higher SDM-Q-9 (P < 0.001) and DCS (P < 0.01) scores than did the CG. For the secondary outcomes, the SDMG had a decreased change of wound size and lower wound management costs than did the CG; nevertheless, the differences were not statistically significant.

Conclusion: We constructed a PDA for PI treatment, which can be applied in clinical care. The pilot test results revealed that the participants had a lower cost related wound treatment and decreasing wound size in SDMG than CG after the intervention of SDM-PI for 4 weeks. In the future, clinical studies should conduct large-scale randomized trials based on the results of this pilot study.

目的:管理压力性损伤(PI)和溃疡的国际指南建议家庭成员和护理人员应参与制定适当的伤口护理决策。然而,共同决策(SDM)在PI背景下的影响尚不清楚。本研究探讨护士主导的医学SDM治疗PI的疗效。材料与方法:我们在护理证据的基础上构建了PI治疗的患者决策辅助系统(PDA)。随后,我们进行了一项随机对照试验,比较SDM与常规护理(对照组,[CG])治疗PI的疗效。3期、4期或不可分期PI的参与者被纳入并随机分为两组。SDM组(SDMG) 10例患者在治疗前接受SDM干预。所有参与者随访4周。主要结果采用SDM问卷(SDM- q -9)和决策冲突量表(DCS)进行测量。次要结局包括伤口大小和伤口处理费用。结果:测量了为PI设计的PDA的专家效度(医学教授和普通人群),内容效度指数为0.96 ~ 0.97。共有20名参与者入组(10名接受SDM治疗,10名接受常规治疗)。参与者的平均年龄为55.7±8.8岁。两组患者的基线特征(性别、年龄、分期或伤口面积)无显著差异。SDMG组的SDM-Q-9评分(P < 0.001)和DCS评分(P < 0.01)均高于CG组。次要结果显示,与CG相比,SDMG的伤口大小变化更小,伤口管理费用更低;然而,差异没有统计学意义。结论:构建了一种用于PI治疗的PDA,可用于临床护理。中试结果显示,在SDM-PI干预4周后,SDMG患者的相关伤口处理成本较CG低,伤口尺寸减小。今后的临床研究应在本初步研究的基础上进行大规模的随机试验。
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引用次数: 0
Percutaneous endoscopic lumbar discectomy versus open lumbar microdiscectomy for treating lumbar disc herniation: Using the survival analysis. 经皮内镜下腰椎间盘切除术与开放式显微腰椎间盘切除术治疗腰椎间盘突出症:使用生存分析。
IF 1.5 Q2 Medicine Pub Date : 2023-07-01 DOI: 10.4103/tcmj.tcmj_262_22
Chang-Hao Lin, Yi-Hung Huang, Fang-Chieh Lien, Cheng-Yi Wu, Lin-Yu Chao

Objectives: This study compared the risk of symptomatic recurrent disc herniation and clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) versus open lumbar microdiscectomy (OLM) for lumbar disc herniation with 2 years of follow-up.

Materials and methods: We analyzed 23 patients who underwent PELD and 32 patients who underwent OLM for lumbar disc herniation. The numeric rating scale of back and leg pain, Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ) were assessed before and at 12 and 24 months after the surgery. The wound pain and complications were also recorded. Survival analysis was performed to estimate the risk of symptomatic recurrent disc herniation.

Results: In the comparison of groups, the reductions in back and leg pain, ODI, and RMDQ were not significantly different at 12 and 24 months. For patients who underwent PELD, the wound pain was significant lower at the day of surgery. The survival rate of patients who were free from symptomatic recurrent disc herniation at 24 months was 0.913 in PELD and 0.875 in OLM, and the log-rank test revealed no significant difference between the two survival curves. The incidence of complication was not significantly different between groups.

Conclusion: Both PELD and OLM are effective treatments for lumbar disc herniation because they have similar clinical outcomes. PELD provided patients with less painful wounds. The survival analysis revealed that the risk of symptomatic recurrent disc herniation in 2 years of follow-up was not different between PELD and OLM.

目的:本研究通过2年的随访比较经皮内窥镜腰椎间盘切除术(PELD)与开放式腰椎间盘微切除术(OLM)治疗腰椎间盘突出症复发的风险和临床结果。材料和方法:我们分析了23例因腰椎间盘突出而行PELD和32例行OLM的患者。分别于术前、术后12个月、24个月评估腰、腿疼痛数值评定量表、Oswestry残疾指数(ODI)、Roland-Morris残疾问卷(RMDQ)。同时记录伤口疼痛及并发症。进行生存分析以估计有症状的复发性椎间盘突出的风险。结果:组间比较,12个月和24个月时腰、腿痛、ODI、RMDQ的减轻无显著性差异。对于接受PELD的患者,在手术当天伤口疼痛明显降低。无症状性复发性椎间盘突出患者24个月生存率PELD组为0.913,OLM组为0.875,log-rank检验显示两组生存率无显著性差异。两组间并发症发生率无明显差异。结论:PELD与OLM治疗腰椎间盘突出症疗效相近,是治疗腰椎间盘突出症的有效方法。PELD减轻了患者的伤口疼痛。生存分析显示,在2年的随访中,PELD和OLM的症状性复发椎间盘突出的风险没有差异。
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引用次数: 0
Coronavirus disease 2019 and cardiovascular disease. 2019冠状病毒病和心血管疾病。
IF 1.5 Q2 Medicine Pub Date : 2023-07-01 DOI: 10.4103/tcmj.tcmj_219_22
Jenn-Yeu Song, Jian-You Huang, Yi-Chiung Hsu, Men-Tzung Lo, Chen Lin, Ta-Chung Shen, Min-Tser Liao, Kuo-Cheng Lu

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus behind the coronavirus disease 2019 (COVID-19) pandemic, is a type of RNA virus that is nonsegmented. Cardiovascular diseases (CVDs) increase the mortality risk of patients. In this review article, we overview the existing evidence regarding the potential mechanisms of myocardial damage in coronavirus disease 2019 (COVID-19) patients. Having a comprehensive knowledge of the cardiovascular damage caused by SARS-CoV-2 and its underlying mechanisms is essential for providing prompt and efficient treatment, ultimately leading to a reduction in mortality rates. Severe COVID-19 causes acute respiratory distress syndrome and shock in patients. In addition, awareness regarding COVID-19 cardiovascular manifestations has increased, including the adverse impact on prognosis with cardiovascular involvement. Angiotensin-converting enzyme 2 receptor may play a role in acute myocardial injury caused by SARS-CoV-2 infection. COVID-19 patients experiencing heart failure may have their condition exacerbated by various contributing factors and mechanisms. Increased oxygen demand, myocarditis, stress cardiomyopathy, elevated pulmonary pressures, and venous thrombosis are potential health issues. The combination of these factors may lead to COVID-19-related cardiogenic shock, resulting in acute systolic heart failure. Extracorporeal membrane oxygenation (ECMO) and left ventricular assist devices (LVADs) are treatment options when inotropic support fails for effective circulatory support. To ensure effective COVID-19-related cardiovascular disease (CVD) surveillance, it is crucial to closely monitor the future host adaptation, viral evolution, and transmissibility of SARS-CoV-2, given the virus's pandemic potential.

2019冠状病毒病(COVID-19)大流行背后的病毒-严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)是一种非分节RNA病毒。心血管疾病(cvd)增加了患者的死亡风险。在这篇综述文章中,我们概述了关于冠状病毒病2019 (COVID-19)患者心肌损伤潜在机制的现有证据。全面了解SARS-CoV-2引起的心血管损伤及其潜在机制,对于提供及时有效的治疗,最终降低死亡率至关重要。严重的COVID-19会导致患者出现急性呼吸窘迫综合征和休克。此外,人们对COVID-19心血管表现的认识有所提高,包括心血管受累对预后的不利影响。血管紧张素转换酶2受体可能在SARS-CoV-2感染引起的急性心肌损伤中起作用。2019冠状病毒病心力衰竭患者的病情可能因各种因素和机制而加剧。需氧量增加、心肌炎、应激性心肌病、肺动脉压升高和静脉血栓形成是潜在的健康问题。这些因素共同作用可能导致新冠肺炎相关心源性休克,导致急性收缩期心力衰竭。当肌力支持失效时,体外膜氧合(ECMO)和左心室辅助装置(lvad)是有效循环支持的治疗选择。鉴于SARS-CoV-2具有大流行的潜力,为确保有效监测covid -19相关心血管疾病(CVD),密切监测其未来的宿主适应、病毒进化和传播性至关重要。
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引用次数: 0
Previous nonhepatectomy abdominal surgery did not increase the difficulty in laparoscopic hepatectomy for hepatocellular carcinoma: A case-control study in 100 consecutive patients. 既往非肝切除腹部手术并未增加肝细胞癌腹腔镜肝切除术的难度:一项连续100例患者的病例对照研究。
IF 1.5 Q2 Medicine Pub Date : 2023-07-01 DOI: 10.4103/tcmj.tcmj_293_22
Yi-Hsuan Lee, Hsiu-Hsien Lin, Tsai-Ling Kuo, Ming-Che Lee, Yen-Cheng Chen

Objectives: Laparoscopic hepatectomy (LH) is still technically challenging for patients with previous nonhepatectomy abdominal surgery (AS). Therefore, this study aimed to assess the difficulty of performing LH for patients with hepatocellular carcinoma (HCC) and a history of nonhepatectomy AS during the initial developing period of LH.

Materials and methods: The retrospective study enrolled patients who were newly diagnosed with HCC receiving LH from January 2013 to June 2021. Demographic characteristics, perioperative variables, and surgical complications were prospectively collected.

Results: One hundred patients were reviewed consecutively, comprising 23 in the AS group and 77 in the non-AS group. No significant differences were observed in median IWATE score (5 vs. 5, P = 0.194), operative time (219 vs. 200 min, P = 0.609), blood loss (100.0 vs. 200.0 mL, P = 0.734), transfusion rate (4.3% vs. 10.4%, P = 0.374), duration of parenchyma transection (90.0 vs. 72.4 min, P = 0.673), and mean nonparenchymal transection time (191.0 vs. 125.0 min, P = 0.228), without increasing the conversion rate (0.0% vs. 3.9%, P = 0.336), postoperative complications (30.3% vs. 33.8%, P = 0.488), and postoperative hospital stay (6 vs. 7 days, P = 0.060) in AS group and non-AS groups.

Conclusion: History of previous nonhepatectomy AS can lead to longer nonparenchymal transection time instead of conversion and did not increase the difficulty. Prolonged nonparenchymal transection time did not increase the surgical complications, prolong the postoperative hospital stay, and compromise the survival outcomes.

目的:腹腔镜肝切除术(LH)对既往非肝切除腹部手术(AS)的患者仍然具有技术挑战性。因此,本研究旨在评估在LH发病初期,肝细胞癌(HCC)患者和有非肝切除术史的AS患者行LH的难度。材料和方法:回顾性研究纳入2013年1月至2021年6月期间接受LH治疗的新诊断HCC患者。前瞻性地收集人口统计学特征、围手术期变量和手术并发症。结果:连续回顾100例患者,其中AS组23例,非AS组77例。没有观察到显著差异岩手县平均得分(5和5,P = 0.194),手术时间(219和200分钟,P = 0.609),失血(100.0 vs 200.0毫升,P = 0.734),输血率(4.3%比10.4%,P = 0.374),期间实质横断(90.0 vs 72.4分钟,P = 0.673),和平均nonparenchymal横断面时间(191.0 vs 125.0分钟,P = 0.228),没有增加转化率(0.0%比3.9%,P = 0.336),术后并发症(30.3%比33.8%,P = 0.488),AS组和非AS组术后住院时间(6天vs 7天,P = 0.060)。结论:既往非肝切除AS病史可导致非实质横断时间延长而非转化,且未增加难度。延长非实质横断时间不会增加手术并发症、延长术后住院时间和影响生存结果。
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引用次数: 0
The effect of oral anticoagulant use before visit for patients with COVID-19 on mortality: A meta-analysis. COVID-19患者就诊前口服抗凝剂对死亡率的影响:一项荟萃分析
IF 1.5 Q2 Medicine Pub Date : 2023-07-01 DOI: 10.4103/tcmj.tcmj_199_22
Cornelia Ghea, Ardyan Wardhana, Alfredo Nugroho, Fika Humaeda Assilmi

Objectives: Anticoagulants have been used as therapeutic or prophylactic agents in COVID-19 and seem to be more beneficial. However, the advantage of oral anticoagulant (OAC) consumption before visit in lowering mortality in COVID-19 patients remains debatable. This meta-analysis aimed to evaluate the effect of OAC use before visit on mortality using the hazard ratio (HR) to estimate the effect of time-to-event endpoints.

Materials and methods: We conducted a literature search in the PubMed and ProQuest databases for any studies comparing groups consuming OAC to no-OAC before visit for mortality in patients with COVID-19. We calculated the overall HRs and their variances across the studies using the random-effects model to obtain pooled estimates.

Results: We included 12 studies which had sample sizes ranging from 70 to 459,402 patients. A meta-analysis comparing OAC therapy and non-OAC consumption in COVID-19 patients before visit revealed no decrease in all-cause mortality (HR = 0.92, 95% confidence interval [CI]: 0.83-1.02, P = 0.12; I2 = 68%). However, subgroup analysis of laboratory-confirmed populations revealed that OAC use before visit had a beneficial effect on mortality (HR = 0.84, 95% CI: 0.73-0.98, P = 0.02; I2 = 56%).

Conclusion: The use of OAC before visit had no beneficial effect on all-cause mortality in COVID-19 patients.

目的:抗凝血剂已被用作COVID-19的治疗或预防药物,似乎更有益。然而,就诊前口服抗凝剂(OAC)在降低COVID-19患者死亡率方面的优势仍存在争议。本荟萃分析旨在评估就诊前使用OAC对死亡率的影响,使用风险比(HR)来估计时间到事件终点的影响。材料和方法:我们在PubMed和ProQuest数据库中进行了文献检索,以比较就诊前服用OAC组和未服用OAC组对COVID-19患者死亡率的影响。我们使用随机效应模型计算了所有研究的总体hr及其方差,以获得汇总估计。结果:我们纳入了12项研究,样本量从70到459,402例患者。一项比较就诊前COVID-19患者OAC治疗和非OAC治疗的荟萃分析显示,全因死亡率没有下降(HR = 0.92, 95%可信区间[CI]: 0.83-1.02, P = 0.12;I2 = 68%)。然而,对实验室确认人群的亚组分析显示,就诊前使用OAC对死亡率有有益影响(HR = 0.84, 95% CI: 0.73-0.98, P = 0.02;I2 = 56%)。结论:就诊前使用OAC对COVID-19患者全因死亡率无显著影响。
{"title":"The effect of oral anticoagulant use before visit for patients with COVID-19 on mortality: A meta-analysis.","authors":"Cornelia Ghea,&nbsp;Ardyan Wardhana,&nbsp;Alfredo Nugroho,&nbsp;Fika Humaeda Assilmi","doi":"10.4103/tcmj.tcmj_199_22","DOIUrl":"https://doi.org/10.4103/tcmj.tcmj_199_22","url":null,"abstract":"<p><strong>Objectives: </strong>Anticoagulants have been used as therapeutic or prophylactic agents in COVID-19 and seem to be more beneficial. However, the advantage of oral anticoagulant (OAC) consumption before visit in lowering mortality in COVID-19 patients remains debatable. This meta-analysis aimed to evaluate the effect of OAC use before visit on mortality using the hazard ratio (HR) to estimate the effect of time-to-event endpoints.</p><p><strong>Materials and methods: </strong>We conducted a literature search in the PubMed and ProQuest databases for any studies comparing groups consuming OAC to no-OAC before visit for mortality in patients with COVID-19. We calculated the overall HRs and their variances across the studies using the random-effects model to obtain pooled estimates.</p><p><strong>Results: </strong>We included 12 studies which had sample sizes ranging from 70 to 459,402 patients. A meta-analysis comparing OAC therapy and non-OAC consumption in COVID-19 patients before visit revealed no decrease in all-cause mortality (HR = 0.92, 95% confidence interval [CI]: 0.83-1.02, <i>P</i> = 0.12; <i>I</i><sup>2</sup> = 68%). However, subgroup analysis of laboratory-confirmed populations revealed that OAC use before visit had a beneficial effect on mortality (HR = 0.84, 95% CI: 0.73-0.98, <i>P</i> = 0.02; <i>I</i><sup>2</sup> = 56%).</p><p><strong>Conclusion: </strong>The use of OAC before visit had no beneficial effect on all-cause mortality in COVID-19 patients.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/67/81/TCMJ-35-226.PMC10399847.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10308305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
An innovation percutaneous needle knife use for trigger finger: A retrospective cohort study. 一种创新的经皮针刺刀用于扳机指:一项回顾性队列研究。
IF 1.5 Q2 Medicine Pub Date : 2023-07-01 DOI: 10.4103/tcmj.tcmj_277_22
Bharath Kumar Velmurugan, Chih-Yang Huang, Dah-Ching Ding, Kun-Chi Wu

Objectives: This study retrospectively evaluated the effectiveness of percutaneous pulley release by our newly designed needle knife in terms of cure, relapse, and complication rates.

Materials and methods: Two hundred and fifty-seven patients were allocated into male and female groups between October 2014 and September 2021. We included patients >15 years of age with a trigger finger (TF) (types II-VI). The primary outcome was the absence of a TF and pain-free movement. In contrast, the secondary outcome included second-time surgery and the number of complications such as infection and admission for antibiotics.

Results: One hundred patients were male, and 157 patients were female. Males and females had mean ages of 62.45 ± 11.76 and 61.50 ± 8.57 years, respectively. The operative time was significantly longer in males than in females (7.88 ± 6.02 vs. 6.52 ± 3.74 min in males and females, respectively, P = 0.027). However, the percentages of diabetes mellitus and gout were the same in both groups. For the percutaneous methods with our needle knife, remission of the trigger was achieved in all cases. In addition, seven patients received revision and three patients with complications. After needle surgery, topical and joint pain scores were improved in both groups (from 5.09 ± 1.31 to 0.80 ± 1.56).

Conclusion: The percutaneous methods with our needle knife displayed effectiveness. The cure rate was high, and the relapse rate was low. Further large-scale clinical trials comparing percutaneous needle to open surgery for releasing the TF will be needed to confirm our results.

目的:本研究回顾性评估我们新设计的针刀经皮滑轮释放术在治愈率、复发率和并发症发生率方面的有效性。材料与方法:2014年10月至2021年9月将257例患者分为男女两组。我们纳入了>15岁的扳机指(TF)患者(II-VI型)。主要结果是没有TF和无痛运动。相比之下,次要结果包括第二次手术和并发症的数量,如感染和抗生素入院。结果:男性100例,女性157例。男女平均年龄分别为62.45±11.76岁和61.50±8.57岁。手术时间男性明显长于女性(7.88±6.02 min vs. 6.52±3.74 min, P = 0.027)。然而,糖尿病和痛风的比例在两组中是相同的。对于经皮方法与我们的针刀,缓解触发器是实现在所有情况下。此外,7例患者接受了翻修,3例患者出现并发症。针刺手术后,两组患者局部和关节疼痛评分均有改善(从5.09±1.31提高到0.80±1.56)。结论:我们的针刀经皮穿刺方法是有效的。治愈率高,复发率低。需要进一步的大规模临床试验来比较经皮针刺和开放手术释放TF的效果,以证实我们的结果。
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引用次数: 0
Corrigendum: Comparison of surgical outcome between conventional open thyroidectomy and endoscopic thyroidectomy through axillo-breast approach. 更正:传统开放式甲状腺切除术与经腋窝-乳房入路的内窥镜甲状腺切除术的手术效果比较。
IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-06-24 eCollection Date: 2023-07-01 DOI: 10.4103/1016-3190.379461

[This corrects the article on p. 286 in vol. 32.].

[这是对第 32 卷第 286 页文章的更正]。
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引用次数: 0
Efficacy and safety of the serratus anterior block compared to thoracic epidural analgesia in surgery: Systematic review and meta-analysis. 手术中前锯肌阻滞与胸椎硬膜外镇痛的疗效和安全性:系统回顾和荟萃分析。
IF 1.5 Q2 Medicine Pub Date : 2023-06-01 eCollection Date: 2023-10-01 DOI: 10.4103/tcmj.tcmj_36_23
Lusianawati, Christian Julio Suhardi, Christrijogo Sumartono, Citrawati Dyah Kencono Wungu

Objectives: The objective of this study was to compare the efficacy and safety of serratus anterior plane block (SAPB) and thoracic epidural analgesia (TEA) in thoracic region surgery.

Materials and methods: We implemented a systematic search of PubMed, ScienceDirect, SCOPUS, and Web of Science and through gray literature for all randomized controlled trials that compared SAPB, a novel thoracic wall nerve block, and TEA in surgery. The evaluated outcomes included the Visual Analog Scale (VAS), hypotension, and postoperative nausea and vomiting (PONV). Review Manager, version 5.4.1, was implemented for the analysis of statistics.

Results: The pooled analysis included six trials that fulfilled the inclusion criteria. In total 384, surgery had received regional blocks (162 - SAPB and 163 - TEA). VAS did not differ significantly between SAPB and TEA, with a mean difference of 0.71, P = 0.08. PONV incidence did not differ significantly between SAPB and TEA (odds ratio = 0.25, P = 0.07). Hypotension incidence was lower in SAPB compared to TEA (odds ratio = 0.10, P = 0.0001).

Conclusion: SAPB yielded comparable VAS with TEA in pain management of thoracic region surgery. The incidence of hypotension was lower in SAPB than in TEA. No difference in PONV incidence was observed. SAPB can be a viable alternative to TEA in thoracic region surgery.

目的:本研究的目的是比较锯肌前平面阻滞(SAPB)和胸椎硬膜外镇痛(TEA)在胸椎手术中的疗效和安全性。材料和方法:我们对PubMed、ScienceDirect、SCOPUS和Web of Science进行了系统检索,并通过灰色文献对所有比较SAPB(一种新型胸壁神经阻滞)和TEA在手术中的随机对照试验进行了检索。评估结果包括视觉模拟评分(VAS)、低血压和术后恶心呕吐(PONV)。Review Manager版本5.4.1是为了统计分析而实现的。结果:合并分析包括6项符合纳入标准的试验。共有384例手术接受了局部阻滞(162例SAPB和163例TEA)。VAS在SAPB和TEA之间无显著差异,平均差异为0.71,P = 0.08。SAPB和TEA的PONV发生率无显著差异(优势比= 0.25,P = 0.07)。与TEA相比,SAPB组低血压发生率较低(优势比= 0.10,P = 0.0001)。结论:SAPB与TEA在胸区手术疼痛管理中的效果相当。SAPB组低血压发生率低于TEA组。PONV发病率无差异。SAPB在胸椎手术中可作为TEA的可行替代方案。
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引用次数: 0
Serum adiponectin level is positively associated with vascular reactivity index by digital thermal monitoring in patients with coronary artery disease. 数字热监测显示冠心病患者血清脂联素水平与血管反应性指数呈正相关。
IF 1.5 Q2 Medicine Pub Date : 2023-06-01 eCollection Date: 2023-10-01 DOI: 10.4103/tcmj.tcmj_30_23
Chien-Hao Hsiao, Bang-Gee Hsu, Chia-Wen Lu, Ji-Hung Wang

Objectives: Adiponectin has anti-inflammatory and antiatherogenic effects and is important in the pathogenesis of cardiovascular diseases. In this cross-sectional study, our objective was to study the potential correlation between serum adiponectin levels and endothelial function in participants with coronary artery disease (CAD).

Materials and methods: We collected serum specimens from 125 fasting participants with CAD. The endothelial function was measured using the vascular reactivity index (VRI) determined by digital thermal monitoring, and VRI values of >2.0, 1.0-1.9, and <1.0 indicated good, intermediate, and poor vascular reactivity, respectively. A commercially available enzyme immunoassay kit was used to measure serum adiponectin levels.

Results: The cohort included 55, 57, and 13 patients with good, intermediate, and poor vascular reactivity, respectively. Poor vascular reactivity was shown to be associated with older age, higher levels of serum total cholesterol, low-density lipoprotein cholesterol (LDL-C), C-reactive protein, and lower levels of serum albumin and adiponectin. The linear regression analysis with multivariable forward stepwise approach revealed that age (β = -0.232), serum LDL-C (β = -0.264), and serum adiponectin (β = 0.574) were correlated with the VRI in CAD patients significantly.

Conclusion: Fasting serum adiponectin levels were associated with good endothelial function determined using the VRI in patients with CAD.

目的:脂联素具有抗炎和抗动脉粥样硬化作用,在心血管疾病的发病机制中起重要作用。在这项横断面研究中,我们的目的是研究冠状动脉疾病(CAD)患者血清脂联素水平与内皮功能之间的潜在相关性。材料和方法:我们收集了125例冠心病空腹受试者的血清标本。采用数字热监测血管反应指数(VRI)测量内皮功能,VRI值>2.0,1.0-1.9。结果:队列中分别包括55例,57例和13例血管反应性良好,中等和较差的患者。研究表明,血管反应性差与年龄较大、血清总胆固醇、低密度脂蛋白胆固醇(LDL-C)、c反应蛋白水平较高、血清白蛋白和脂联素水平较低有关。多变量正逐步线性回归分析显示,年龄(β = -0.232)、血清LDL-C (β = -0.264)、血清脂联素(β = 0.574)与冠心病患者VRI有显著相关性。结论:用VRI测定冠心病患者空腹血清脂联素水平与良好的内皮功能相关。
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引用次数: 0
Retrograde ureteral catheterization under local anesthesia for emergency drainage in patients with infection and hydronephrosis secondary to ureteral calculi: Experience from a tertiary care hospital. 局部麻醉下逆行输尿管导尿管置管术用于输尿管结石感染并发肾积水的急诊引流:来自三级医院的经验。
IF 1.5 Q2 Medicine Pub Date : 2023-05-17 eCollection Date: 2023-10-01 DOI: 10.4103/tcmj.tcmj_11_23
Chun-Kai Hsu, Wan-Ling Young, Shu-Yu Wu

Objectives: The aim is to evaluate the safety and efficacy of retrograde ureteral catheterization under local anesthesia in patients with urinary tract infections complicated by hydronephrosis caused by ureteral stone obstruction.

Materials and methods: From October 2020 to September 2021, a retrospective analysis of patients' medical records was performed. Records of past history, physical examination, laboratory tests, and imaging investigations were reviewed. Retrograde ureteric stent (RUS) was performed under local anesthesia using cystoscopes and guided by portable fluoroscopy. Real-time fluoroscopy was used to verify the double-J stent position and confirm a smooth process. The postoperative recovery and length of admission were also recorded.

Results: A total of 14 patients with ureteral stone obstruction with infective hydronephrosis received 15 total emergency RUS procedures (one bilateral). Intraoperative findings, operation times, and infection signs were recorded and analyzed. All patients met systemic infection criteria, with a mean body temperature of 38.7°C ± 1.7°C. Leukocytosis was noted in 8 (57.1%) patients. Elevated C-reactive protein (8.5 ± 6.3 mg/L) and procalcitonin (24.1 ± 22.0 ng/mL) were found in 13 (92.9%) and 9 (64.3%) patients, respectively. Mean stone size was 8.5 ± 6.3 mm, mostly localized to the upper ureter (upper: 12; middle: 0; lower: 3). Mean operation time was 14.1 ± 4.3 min. After emergency drainage, all patients improved and were discharged after infection was controlled. The average length of admission was 6.2 ± 2.2 days.

Conclusion: RUS under local anesthesia is safe and effective for treating infective hydronephrosis due to ureteral stone obstruction. A randomized controlled trial with a large sample remains necessary to validate these findings.

目的:评价局麻下行输尿管逆行导尿管术治疗输尿管结石梗阻致尿路感染并发肾积水患者的安全性和有效性。材料与方法:对2020年10月至2021年9月患者病历进行回顾性分析。回顾病史、体格检查、实验室检查和影像学检查记录。膀胱镜下行输尿管逆行支架置入,便携式透视引导下行局部麻醉。实时透视检查用于验证双j型支架的位置,并确认过程顺利。记录术后恢复情况和住院时间。结果:输尿管结石梗阻合并感染性肾积水患者共14例接受了15例急诊RUS手术(1例双侧)。记录并分析术中发现、手术时间和感染体征。所有患者均符合全身性感染标准,平均体温38.7℃±1.7℃。白细胞增多8例(57.1%)。c反应蛋白升高(8.5±6.3 mg/L) 13例(92.9%),降钙素原升高(24.1±22.0 ng/mL) 9例(64.3%)。平均结石大小为8.5±6.3 mm,主要局限于输尿管上部(上部:12;中间:0;平均手术时间14.1±4.3 min。经紧急引流后,所有患者病情好转,感染控制后出院。平均住院时间为6.2±2.2 d。结论:局麻RUS治疗输尿管结石梗阻性感染性肾积水安全有效。需要一个大样本的随机对照试验来验证这些发现。
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Tzu Chi Medical Journal
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