BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion...BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.展开更多
目的综合评价接骨七厘胶囊与接骨七厘片用于骨折术后患者的有效性、安全性、经济性。方法采用网状Meta分析进行接骨七厘胶囊与接骨七厘片治疗骨折术后患者有效率的比较。调取国家药品不良反应中心接骨七厘胶囊与接骨七厘片的不良反应数...目的综合评价接骨七厘胶囊与接骨七厘片用于骨折术后患者的有效性、安全性、经济性。方法采用网状Meta分析进行接骨七厘胶囊与接骨七厘片治疗骨折术后患者有效率的比较。调取国家药品不良反应中心接骨七厘胶囊与接骨七厘片的不良反应数据,通过χ^(2)检验评估两者不良反应发生率的差异。通过TreeAge Pro 2022构建决策树模型,从中国医疗卫生系统视角开展药物经济学评价,采用增量成本-效果比(ICER)评估接骨七厘胶囊与接骨七厘片用于骨折术后患者的经济性,并进行敏感性分析。结果进行接骨七厘片方案与接骨七厘胶囊方案的比较,其RR(95%CI)为1.06(0.85,1.37),包含无效线1,表明两者有效率比较差异无统计学意义。接骨七厘胶囊和接骨七厘片总体不良反应发生率为0.78‰和4.16‰,接骨七厘胶囊总体和各类不良反应发生率均低于接骨七厘片,差异有统计学意义(P<0.01)。相比于接骨七厘片,患者使用接骨七厘胶囊有效率增加0.0549,成本增加了104.04元,ICER值为1893.97元,低于意愿支付阈值,具有经济学优势。敏感性分析结果表明基础分析结果较稳健。结论接骨七厘胶囊与接骨七厘片用于骨折术后治疗的有效性相当,但与接骨七厘片相比,接骨七厘胶囊安全性更高,且更具经济学优势。展开更多
BACKGROUND Tracheoesophageal fistula(TEF)is a life-threatening complication of advanced esophageal squamous cell carcinoma(ESCC).Cervical ESCC is rare and frequently diagnosed at an advanced stage.Managing cervical es...BACKGROUND Tracheoesophageal fistula(TEF)is a life-threatening complication of advanced esophageal squamous cell carcinoma(ESCC).Cervical ESCC is rare and frequently diagnosed at an advanced stage.Managing cervical esophageal cancer(CEC)is challenging,requiring intervention by a multidisciplinary team(MDT)and innovative surgical management.CASE SUMMARY Here,we present a 59-year-old male patient with a 5-month history of CEC and difficulty eating for over 20 days,who developed TEF secondary to recurrent ESCC after chemoradiotherapy.He underwent total pharyngolaryngoesophagectomy,left thyroidectomy,and lymphadenectomy.Gastric pull-up was performed to restore gastrointestinal continuity,and a 7 cm×5 cm supraclavicular artery island flap(SCAIF)was used to reconstruct the lower tracheal defect.Despite severe postoperative complications,he recovered by successful management by a MDT.A 7 cm×6 cm pectoralis major myocutaneous flap was successfully used to repair the necrotic gastric conduit defect.The patient recovered,regaining the ability to eat and breathe effectively.At the 27-month follow-up,he was alive without recurrence or metastasis.CONCLUSION This study highlights the efficacy of gastric pull-up and SCAIF reconstruction in managing TEF secondary to recurrent ESCC.展开更多
BACKGROUND Surgery is the gold standard for gallstone treatment.Nevertheless,the complications associated with the surgical procedure can exert diverse and adverse impacts on patients’health and quality of life to va...BACKGROUND Surgery is the gold standard for gallstone treatment.Nevertheless,the complications associated with the surgical procedure can exert diverse and adverse impacts on patients’health and quality of life to varying extents.Hence,it is essential to offer perioperative care to patients undergoing gallstone surgery.AIM To examine the impact of perioperative comprehensive nursing on pain intensity,complication rates,and patient comfort in individuals undergoing gallstone surgery.METHODS From February 2022 to February 2024,195 patients who underwent gallstone surgery at Sanmen People’s Hospital were selected and divided into two groups:A control group receiving routine nursing care(95 patients)and a research group receiving perioperative comprehensive nursing(100 patients).Key postoperative recovery indicators,including time to first postoperative anal exhaust,oral food intake,and ambulation,were observed,along with pain intensity(measured by the numeric rating scale),complication rate(bleeding,incision infection,recurrence),patient comfort(assessed using the visual analogue scale),and quality of life(measured by the World Health Organization Quality of Life-BREF).RESULTS The research group showed significantly shorter times to first postoperative anal exhaust,oral intake,and ambulation.Moreover,numeric rating scale pain scores in the research group were markedly lower post-nursing,and the total complication rate was significantly reduced compared to the control group.Furthermore,comfort levels improved considerably in the research group,and World Health Organization Quality of Life-BREF scores across the physical,psychological,social,and environmental domains were significantly higher compared to the control group following nursing care.CONCLUSION Perioperative comprehensive nursing effectively enhances postoperative recovery in patients undergoing gallstone surgery,reducing pain,lowering complications,and improving patient comfort and quality of life,which deserves clinical application.展开更多
Currently,polymer nanosponges have received extensive attention.However,developing new synthetic techniques for novel nanosponges remains a challenge.Furthermore,to date,composite nanosponge adsorbents based on waterb...Currently,polymer nanosponges have received extensive attention.However,developing new synthetic techniques for novel nanosponges remains a challenge.Furthermore,to date,composite nanosponge adsorbents based on waterborne polyurethane(WPU)andβ-cyclodextrin(β-CD)have not been reported.Herein,a novel green method,ion condensation method,was developed in this study for the preparation of polymer nanosponge adsorbents for efficient removal of dyes from wastewater.Based on the principle of charge repulsion between nanoparticles to maintain emulsion stability,waterborne polyurethane/β-cyclodextrin composite nanosponges(WPU-x,y)were prepared by coagulating the emulsions synthesized from 2,2-dimethylolpropionic acid,polypropylene glycol and hexamethylene diisocyanate as raw materials in a mixture of hydrochloric acid and anhydrous ethanol.The structure and appearance of WPU-x,y were characterized by attenuated total reflectance Fourier transform infrared spectroscopy,thermal gravimetric analyzer,scanning electron microscope and mercury intrusion porosimetry.The adsorption capacity of WPU-x,y was tested by parameters such as cross-linking degree,β-CD dosage,contact time,initial dye concentration and p H value.The study found that WPU-4,4.62 had the best adsorption effect on methylene blue(MB),the maximum removal rate was 93.42%,and the maximum adsorption capacity was 136.03 mg·g^(-1).Moreover,the Sips isotherm and pseudo-second-order-model were suitable for MB adsorption.Therefore,this study provides some perspectives for the fabrication of nanosponge adsorbents.展开更多
文摘BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.
文摘目的综合评价接骨七厘胶囊与接骨七厘片用于骨折术后患者的有效性、安全性、经济性。方法采用网状Meta分析进行接骨七厘胶囊与接骨七厘片治疗骨折术后患者有效率的比较。调取国家药品不良反应中心接骨七厘胶囊与接骨七厘片的不良反应数据,通过χ^(2)检验评估两者不良反应发生率的差异。通过TreeAge Pro 2022构建决策树模型,从中国医疗卫生系统视角开展药物经济学评价,采用增量成本-效果比(ICER)评估接骨七厘胶囊与接骨七厘片用于骨折术后患者的经济性,并进行敏感性分析。结果进行接骨七厘片方案与接骨七厘胶囊方案的比较,其RR(95%CI)为1.06(0.85,1.37),包含无效线1,表明两者有效率比较差异无统计学意义。接骨七厘胶囊和接骨七厘片总体不良反应发生率为0.78‰和4.16‰,接骨七厘胶囊总体和各类不良反应发生率均低于接骨七厘片,差异有统计学意义(P<0.01)。相比于接骨七厘片,患者使用接骨七厘胶囊有效率增加0.0549,成本增加了104.04元,ICER值为1893.97元,低于意愿支付阈值,具有经济学优势。敏感性分析结果表明基础分析结果较稳健。结论接骨七厘胶囊与接骨七厘片用于骨折术后治疗的有效性相当,但与接骨七厘片相比,接骨七厘胶囊安全性更高,且更具经济学优势。
基金Supported by the Key R&D Program of Zhejiang,No.2023C03066and National natural science foundation of China,No.82471148.
文摘BACKGROUND Tracheoesophageal fistula(TEF)is a life-threatening complication of advanced esophageal squamous cell carcinoma(ESCC).Cervical ESCC is rare and frequently diagnosed at an advanced stage.Managing cervical esophageal cancer(CEC)is challenging,requiring intervention by a multidisciplinary team(MDT)and innovative surgical management.CASE SUMMARY Here,we present a 59-year-old male patient with a 5-month history of CEC and difficulty eating for over 20 days,who developed TEF secondary to recurrent ESCC after chemoradiotherapy.He underwent total pharyngolaryngoesophagectomy,left thyroidectomy,and lymphadenectomy.Gastric pull-up was performed to restore gastrointestinal continuity,and a 7 cm×5 cm supraclavicular artery island flap(SCAIF)was used to reconstruct the lower tracheal defect.Despite severe postoperative complications,he recovered by successful management by a MDT.A 7 cm×6 cm pectoralis major myocutaneous flap was successfully used to repair the necrotic gastric conduit defect.The patient recovered,regaining the ability to eat and breathe effectively.At the 27-month follow-up,he was alive without recurrence or metastasis.CONCLUSION This study highlights the efficacy of gastric pull-up and SCAIF reconstruction in managing TEF secondary to recurrent ESCC.
基金Supported by Science and Technology Program of Sanmen County Public Technology Social Development Project,No.24227.
文摘BACKGROUND Surgery is the gold standard for gallstone treatment.Nevertheless,the complications associated with the surgical procedure can exert diverse and adverse impacts on patients’health and quality of life to varying extents.Hence,it is essential to offer perioperative care to patients undergoing gallstone surgery.AIM To examine the impact of perioperative comprehensive nursing on pain intensity,complication rates,and patient comfort in individuals undergoing gallstone surgery.METHODS From February 2022 to February 2024,195 patients who underwent gallstone surgery at Sanmen People’s Hospital were selected and divided into two groups:A control group receiving routine nursing care(95 patients)and a research group receiving perioperative comprehensive nursing(100 patients).Key postoperative recovery indicators,including time to first postoperative anal exhaust,oral food intake,and ambulation,were observed,along with pain intensity(measured by the numeric rating scale),complication rate(bleeding,incision infection,recurrence),patient comfort(assessed using the visual analogue scale),and quality of life(measured by the World Health Organization Quality of Life-BREF).RESULTS The research group showed significantly shorter times to first postoperative anal exhaust,oral intake,and ambulation.Moreover,numeric rating scale pain scores in the research group were markedly lower post-nursing,and the total complication rate was significantly reduced compared to the control group.Furthermore,comfort levels improved considerably in the research group,and World Health Organization Quality of Life-BREF scores across the physical,psychological,social,and environmental domains were significantly higher compared to the control group following nursing care.CONCLUSION Perioperative comprehensive nursing effectively enhances postoperative recovery in patients undergoing gallstone surgery,reducing pain,lowering complications,and improving patient comfort and quality of life,which deserves clinical application.
基金supported by the National Natural Science Foundation of China(21704047,21801145)the Natural Science Foundation of Shandong Province(ZR2017BB078,ZR2021QE137)+1 种基金the Foundation(ZZ20190407)of State Key Laboratory of Biobased Material and Green Papermakingthe Major Scientific and Technological Innovation Projects of Shandong Province(2019JZZY020230)。
文摘Currently,polymer nanosponges have received extensive attention.However,developing new synthetic techniques for novel nanosponges remains a challenge.Furthermore,to date,composite nanosponge adsorbents based on waterborne polyurethane(WPU)andβ-cyclodextrin(β-CD)have not been reported.Herein,a novel green method,ion condensation method,was developed in this study for the preparation of polymer nanosponge adsorbents for efficient removal of dyes from wastewater.Based on the principle of charge repulsion between nanoparticles to maintain emulsion stability,waterborne polyurethane/β-cyclodextrin composite nanosponges(WPU-x,y)were prepared by coagulating the emulsions synthesized from 2,2-dimethylolpropionic acid,polypropylene glycol and hexamethylene diisocyanate as raw materials in a mixture of hydrochloric acid and anhydrous ethanol.The structure and appearance of WPU-x,y were characterized by attenuated total reflectance Fourier transform infrared spectroscopy,thermal gravimetric analyzer,scanning electron microscope and mercury intrusion porosimetry.The adsorption capacity of WPU-x,y was tested by parameters such as cross-linking degree,β-CD dosage,contact time,initial dye concentration and p H value.The study found that WPU-4,4.62 had the best adsorption effect on methylene blue(MB),the maximum removal rate was 93.42%,and the maximum adsorption capacity was 136.03 mg·g^(-1).Moreover,the Sips isotherm and pseudo-second-order-model were suitable for MB adsorption.Therefore,this study provides some perspectives for the fabrication of nanosponge adsorbents.
