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Glycemic control in critically ill surgical patients: risks and benefits 外科危重病人的血糖控制:风险与益处
IF 1 Q4 SURGERY Pub Date : 2015-03-19 DOI: 10.2147/OAS.S50416
K. Mukherjee, Vance L. Albaugh, J. Richards, Kelli A. Rumbaugh, A. May
Glucose metabolism in humans is exceedingly complex. At baseline, it is controlled by elaborate signaling mechanisms, and these mechanisms are profoundly altered by the surge of catecholamines and cytokines associated with acute postsurgical and post-traumatic stress. These alterations in signaling mechanisms result in hyperglycemia; although this hyperglycemia can start very rapidly after the traumatic or surgical insult, it can persist during the entire period of critical illness and even afterward. Numerous randomized clinical trials have been conducted to determine if hyperglycemia is associated with increased mortality in surgical patients. These studies have had different conclusions that are difficult to interpret in light of differences in study methodology, but there is certainly ample evidence that inadequately controlled hyperglycemia causes harm due to increased infectious morbidity, and possibly increased mortality. As we have become more proficient in controlling hyperglycemia, the concept of insulin resistance, determined as the amount of insulin required to achieve hyperglycemia, has come to the fore. Insulin resistance is not a static concept, and may change before significant events such as infection. Patients with elevated and persistent insulin resistance have been demonstrated to suffer increased infectious morbidity and mortality, albeit in nonrandomized studies. Along with insulin resistance, the concept of glycemic variability, the amount of variation in serum blood glucose over time, has also become relevant; increased variability has been associated with hypoglycemia and mortality. Both of these risks can result from aggressive insulin therapy, and glycemic control protocols must be appropriately planned and implemented to avoid hypo- glycemia and excessive externally induced variability. Computer-assisted protocols may be of significant benefit in optimizing glycemic control. The most recent recommendations available are to keep serum blood glucose levels below 150 mg/dL and to avoid hypoglycemia.
人类的葡萄糖代谢非常复杂。在基线,它是由复杂的信号机制控制的,这些机制被与急性术后和创伤后应激相关的儿茶酚胺和细胞因子的激增深刻地改变。这些信号机制的改变导致高血糖;虽然这种高血糖可以在创伤或手术损伤后迅速开始,但它可以在整个危重疾病期间甚至之后持续存在。已经进行了大量随机临床试验,以确定高血糖是否与手术患者死亡率增加有关。这些研究得出了不同的结论,由于研究方法的差异,这些结论很难解释,但确实有充分的证据表明,控制不当的高血糖会增加传染性发病率,并可能增加死亡率,从而造成危害。随着我们在控制高血糖方面变得越来越熟练,胰岛素抵抗的概念,即达到高血糖所需的胰岛素量,已经脱颖而出。胰岛素抵抗不是一个静态的概念,在感染等重大事件发生之前可能会发生变化。尽管是在非随机研究中,但已证明胰岛素抵抗升高且持续的患者感染发病率和死亡率增加。随着胰岛素抵抗,血糖变异性的概念,血清血糖随时间变化的量,也变得相关;变异性的增加与低血糖和死亡率有关。这两种风险都可能由积极的胰岛素治疗引起,必须适当地计划和实施血糖控制方案,以避免低血糖和过度的外部诱导变异性。计算机辅助方案在优化血糖控制方面可能有显著的益处。最新的建议是将血清血糖水平保持在150毫克/分升以下,避免低血糖。
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引用次数: 7
Early abdominal closure using component separation in patients with an open abdomen after trauma: a pilot study 创伤后开放腹部患者早期使用成分分离进行腹部闭合:一项初步研究
IF 1 Q4 SURGERY Pub Date : 2015-02-24 DOI: 10.2147/OAS.S47805
K. Chopra, K. Tadisina, Jamil A. Matthews, J. Sabino, Devinder Singh, W. Habre
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Open Access Surgery 2015:8 21–26 Open Access Surgery Dovepress
许可证。许可的完整条款可在http://creativecommons.org/licenses/by-nc/3.0/上获得。允许非商业用途的工作,没有任何进一步的许可,从多芬医学出版社有限公司,只要工作适当署名。超出许可范围的许可由多芬医疗新闻有限公司管理。有关如何请求许可的信息可在http://www.dovepress.com/permissions.php Open Access Surgery 2015:8 21-26 Open Access Surgery Dovepress上找到
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引用次数: 2
How many meals should you skip before undergoing a colonoscopy? A randomized controlled trial: association between duration of abstinence from solid food to cleanliness of the bowel in patients undergoing elective colonoscopy 在做结肠镜检查之前,你应该少吃几顿饭?一项随机对照试验:选择性结肠镜检查患者禁食固体食物时间与肠道清洁度之间的关系
IF 1 Q4 SURGERY Pub Date : 2015-01-29 DOI: 10.2147/OAS.S74996
D. Aziz, Loh H Peow, Jasiah Zakaria, Mahmud Mohd Nor, Z. Latiff
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Open Access Surgery 2015:8 9–20 Open Access Surgery Dovepress
许可证。许可的完整条款可在http://creativecommons.org/licenses/by-nc/3.0/上获得。允许非商业用途的工作,没有任何进一步的许可,从多芬医学出版社有限公司,只要工作适当署名。超出许可范围的许可由多芬医疗新闻有限公司管理。有关如何请求许可的信息可在http://www.dovepress.com/permissions.php Open Access Surgery 2015:8 9-20 Open Access Surgery Dovepress上找到
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引用次数: 0
Ex vivo and in vivo evaluation of an ultrasonic device for precise dissection, coagulation, and transection 用于精确解剖、凝血和横断的超声装置的体外和体内评价
IF 1 Q4 SURGERY Pub Date : 2014-12-18 DOI: 10.2147/OAS.S73851
Brian D. Bertke, P. Scoggins, Alissa L. Welling, Tamara V. Widenhouse, Chaoyang Chen, S. Kallakuri, J. Cavanaugh, J. Clymer, Joseph F. Amaral
Background: A new ultrasonic device, Harmonic Focus ® + , has been developed that is smaller and delivers energy more efficiently than its predecessor via the inclusion of Adaptive Tissue Technology. This study was undertaken to compare its dissection capabilities to an advanced bipolar electrosurgery device in benchtop and preclinical evaluations. Methods: In ex vivo testing, Focus + and LigaSure™ Small Jaw were evaluated for physical dimensions, device and tissue temperature after repeated applications to porcine jejunum, and burst pressure of vessel seals, transection time, and tissue sticking in 3–5 mm porcine carotid arteries. In in vivo testing, the devices were tested on intact porcine carotid arteries for thermal damage via collagen denaturation and in muscle incisions near rat sciatic nerve for acute inflammation via hematoxylin and eosin and for impaired axonal transport via β -APP. Results: Focus + was smaller than the Small Jaw in width and height, yet it had a longer active blade and larger jaw aperture. Device temperatures were not different after application, but thermal spread (tissue temperature above 50 ° C) was 78% greater for Small Jaw (9.6 mm) than for Focus + (5.4 mm). Burst pressures of sealed vessels were not significantly different between the devices: 900 ( ± 466) mmHg for Focus + versus 974 ( ± 500) mmHg for Small Jaw. Small Jaw had a shorter individual transection time (5.0 seconds compared to 6.3 seconds for Focus + ), whereas Focus + had 70% less tissue sticking. Thermal damage, neural inflammation, and impaired axonal transport were all significantly lower for Focus + compared to Small Jaw, by 19%, 57%, and 50%, respectively. Conclusion: With the addition of Adaptive Tissue Technology, Harmonic Focus + builds upon the manifold advantages of ultrasonic devices in procedures requiring meticulous dissecting capability. Improvements in energy sensing and controlled delivery produce lower tissue temperatures and less thermal damage, especially critical when working near nerves. Focus + produces vessel seal strengths equivalent to advanced bipolar devices and, although individual device activations are longer, the reduction in tissue sticking is expected to materially lessen operative time in clinical practice.
背景:一种新的超声波设备,谐波焦点®+,已经开发出更小,更有效地传递能量比其前身通过包含自适应组织技术。本研究的目的是在台式和临床前评估中将其解剖能力与先进的双极电手术设备进行比较。方法:在离体实验中,评估Focus +和LigaSure™Small Jaw在猪空肠重复应用后的物理尺寸、设备和组织温度,以及血管密封破裂压力、横断时间和3-5 mm猪颈动脉组织粘附情况。在体内测试中,通过胶原变性对完整的猪颈动脉进行热损伤测试,通过苏木精和伊红对大鼠坐骨神经附近的肌肉切口进行急性炎症测试,通过β -APP对轴突运输受损进行测试。结果:Focus +在宽度和高度上均小于Small Jaw,但其活动叶片较长,下颌孔径较大。应用后设备温度没有差异,但小颚(9.6 mm)的热扩散(组织温度高于50°C)比Focus + (5.4 mm)大78%。两种设备之间密封血管的破裂压力无显著差异:Focus +为900(±466)mmHg, Small Jaw为974(±500)mmHg。Small Jaw的个体横断时间较短(5.0秒,而Focus +为6.3秒),而Focus +的组织粘连减少了70%。与Small Jaw相比,Focus +的热损伤、神经炎症和轴突运输损伤均显著降低,分别降低19%、57%和50%。结论:随着自适应组织技术的加入,谐波聚焦+在需要细致解剖能力的手术中发挥了超声设备的多方面优势。能量传感和控制输送的改进可以降低组织温度,减少热损伤,这在神经附近工作时尤为重要。Focus +产生的血管密封强度相当于先进的双极装置,尽管单个装置的激活时间更长,但减少组织粘连有望在临床实践中大大减少手术时间。
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引用次数: 5
Advances in abdominal access for laparoscopic surgery: a review 腹腔镜手术腹部通路研究进展综述
IF 1 Q4 SURGERY Pub Date : 2014-11-19 DOI: 10.2147/OAS.S47328
M. Ogaick, G. Martel
There are several laparoscopic surgery abdominal wall access techniques. The most useful and well-established is the open Hasson technique. The Veress needle closed technique is another alternative, but its use is controversial owing to possibly higher rates of rare insertion complications. Optical trocars have been developed in an attempt to decrease complication rates even further, although the evidence base supporting their use is limited. Single-incision laparo- scopic surgery (SILS) is used in certain centers to carry out various abdominal surgeries, but most commonly appendectomy and cholecystectomy. To date, SILS appears safe and feasible, with possibly greater costs and operative time. Natural orifice translumenal endoscopic surgery (NOTES) is an evolving area of incisionless surgery. While some progress has been made in achieving transgastric or transvaginal peritoneal endoscopic access, this technique remains
有几种腹腔镜手术腹壁进入技术。最有用和最完善的是开放哈森技术。Veress针闭合技术是另一种选择,但其使用存在争议,因为其置入并发症的发生率可能更高。光学套管针的开发是为了进一步降低并发症发生率,尽管支持其使用的证据基础有限。单切口腹腔镜手术(SILS)在某些中心被用于进行各种腹部手术,但最常见的是阑尾切除术和胆囊切除术。到目前为止,SILS似乎是安全可行的,但可能需要更高的成本和手术时间。自然孔腔内窥镜手术(NOTES)是一个不断发展的无切口手术领域。虽然在实现经胃或经阴道腹膜内窥镜进入方面取得了一些进展,但这种技术仍然存在
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引用次数: 3
Fibrin sealant patches: powerful and easy-to-use hemostats 纤维蛋白密封贴片:功能强大且易于使用的止血剂
IF 1 Q4 SURGERY Pub Date : 2014-09-18 DOI: 10.2147/OAS.S41516
W. Spotnitz
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Open Access Surgery 2014:7 71–79 Open Access Surgery Dovepress
许可证。许可的完整条款可在http://creativecommons.org/licenses/by-nc/3.0/上获得。允许非商业用途的工作,没有任何进一步的许可,从多芬医学出版社有限公司,只要工作适当署名。超出许可范围的许可由多芬医疗新闻有限公司管理。有关如何请求许可的信息可在http://www.dovepress.com/permissions.php Open Access Surgery 2014:7 71-79 Open Access Surgery Dovepress上找到
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引用次数: 6
Laparoscopic partial nephrectomy: state of the art review 腹腔镜肾部分切除术:最新进展
IF 1 Q4 SURGERY Pub Date : 2014-05-27 DOI: 10.2147/OAS.S40275
I. Faiena, C. Han, E. Olweny
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Open Access Surgery 2014:7 59–69 Open Access Surgery Dovepress
许可证。许可的完整条款可在http://creativecommons.org/licenses/by-nc/3.0/上获得。允许非商业用途的工作,没有任何进一步的许可,从多芬医学出版社有限公司,只要工作适当署名。超出许可范围的许可由多芬医疗新闻有限公司管理。有关如何请求许可的信息可在http://www.dovepress.com/permissions.php Open Access Surgery 2014:7 59-69 Open Access Surgery Dovepress上找到
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引用次数: 0
Robotic radical cystectomy in bladder cancer: is it the future? 机器人根治性膀胱切除术治疗膀胱癌:这是未来吗?
IF 1 Q4 SURGERY Pub Date : 2014-05-24 DOI: 10.2147/OAS.S42290
A. Canda, A. Atmaca, M. Arslan, M. Keske, O. U. Cakici, S. Çakmak, D. Kamaci, Emre Urer
Open radical cystectomy (RC) is the gold standard surgical approach in the management of muscle invasive bladder cancer in addition to high-grade, recurrent, noninvasive tumors. With the development of surgical robotic technology, robotic-assisted laparoscopic radical cystectomy (RARC) is increasingly being performed as a minimally invasive surgical approach. A learning curve exists with a recommended case number of at least 20 RARC procedures in order to achieve satisfying outcomes in terms of operation time, complication rate, and onco- logical outcomes, including positive surgical margins (SMs) and lymph node (LN) yield. In the current literature, long-term outcomes of RARC are not yet available. Due to the outcomes of the published literature, RARC seems to have satisfactory oncologic and functional outcomes in addition to acceptable complication rates. Intraoperative blood loss and transfusion rates seem to be decreased in RARC series when compared to open approaches. On the other hand, a number of authors have reported decreased complication rates but increased operation time in the robotic approach. Similar oncologic results including positive SM rates and LN yields were detected in most comparative publications. Totally intracorporeal RARC with urinary diversion is a complex procedure and the number of centers performing this type of surgery is currently very limited. Although, it is still too early to make strict conclusions about RARC, RARC with intracorporeal urinary diversion has the potential to be the future of robotic bladder cancer surgery. Therefore, further prospective and randomized studies with increased numbers of patients and with longer follow-up are needed. Lastly, RARC may be related to increased cost when compared to open surgery, although controversial reports exist about this issue.
开放根治性膀胱切除术(RC)是治疗肌肉浸润性膀胱癌的金标准手术方法,也是治疗高级别、复发性、非侵袭性肿瘤的金标准手术方法。随着手术机器人技术的发展,机器人辅助腹腔镜根治性膀胱切除术(RARC)作为一种微创手术方式越来越多地被应用。为了在手术时间、并发症发生率和肿瘤预后(包括阳性手术切缘(SMs)和淋巴结(LN)产率方面达到令人满意的结果,推荐病例数至少为20例RARC手术存在学习曲线。在目前的文献中,RARC的长期结果尚未得到。根据已发表文献的结果,除了可接受的并发症发生率外,RARC似乎具有令人满意的肿瘤和功能结果。与开放入路相比,RARC系列术中出血量和输血率似乎有所降低。另一方面,一些作者报道了机器人入路的并发症发生率降低,但手术时间增加。类似的肿瘤学结果,包括阳性SM率和LN产率在大多数比较出版物中检测到。全体内RARC伴尿路转移是一项复杂的手术,目前开展此类手术的中心数量非常有限。虽然现在对RARC做出严格的结论还为时过早,但RARC结合体内尿转移有可能成为机器人膀胱癌手术的未来。因此,需要进一步的前瞻性和随机化研究,增加患者数量,延长随访时间。最后,与开放手术相比,RARC可能与成本增加有关,尽管关于这个问题存在争议的报道。
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引用次数: 1
Longitudinal sleeve gastrectomy: current perspectives 纵向袖胃切除术:目前的观点
IF 1 Q4 SURGERY Pub Date : 2014-05-14 DOI: 10.2147/OAS.S41497
E. Soricelli, G. Casella, G. Rocco, A. Redler, N. Basso
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Open Access Surgery 2014:7 35–46 Open Access Surgery Dovepress
许可证。许可的完整条款可在http://creativecommons.org/licenses/by-nc/3.0/上获得。允许非商业用途的工作,没有任何进一步的许可,从多芬医学出版社有限公司,只要工作适当署名。超出许可范围的许可由多芬医疗新闻有限公司管理。有关如何请求许可的信息可在http://www.dovepress.com/permissions.php Open Access Surgery 2014:7 35-46 Open Access Surgery Dovepress上找到
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引用次数: 4
Transcatheter closure of secundum atrial septal defect in adults: report of our first experience in a developing country 经导管关闭成人第二房间隔缺损:我们在发展中国家的首次经验报告
IF 1 Q4 SURGERY Pub Date : 2014-04-16 DOI: 10.2147/OAS.S38204
A. Animasahun, Yele Aluko, Adeyemi Johnson, K. Ogunyankin, S. Maheshwari
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Open Access Surgery 2014:7 29–33 Open Access Surgery Dovepress
许可证。许可的完整条款可在http://creativecommons.org/licenses/by-nc/3.0/上获得。允许非商业用途的工作,没有任何进一步的许可,从多芬医学出版社有限公司,只要工作适当署名。超出许可范围的许可由多芬医疗新闻有限公司管理。有关如何请求许可的信息可在http://www.dovepress.com/permissions.php Open Access Surgery 2014:7 29-33 Open Access Surgery Dovepress上找到
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引用次数: 1
期刊
Open Access Surgery
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