Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary su...Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary surgery subsequent to experiencing breakthrough infection of coronavirus disease 2019(COVID-19).This study aimed to find factors predicting postoperative complications and construct an innovative nomogram to pinpoint patients who were susceptible to developing severe complications following breakthrough infection of COVID-19 after undergoing elective hepato-pancreato-biliary surgery.Methods:This multicenter retrospective cohort study included consecutive patients who underwent elective hepato-pancreato-biliary surgeries between January 3 and April 1,2023 from four hospitals in China.All of these patients had experienced breakthrough infection of COVID-19 prior to their surgeries.Additionally,two groups of patients without preoperative COVID-19 infection were included as comparative controls.Surgical complications were meticulously documented and evaluated using the comprehensive complication index(CCI),which ranged from 0(uneventful course)to 100(death).A CCI value of 20.9 was identified as the threshold for defining severe complications.Results:Among 2636 patients who were included in this study,873 were included in the reference group I,941 in the reference group II,389 in the internal cohort,and 433 in the external validation cohort.Multivariate logistic regression analysis revealed that completing a full course of COVID-19 vaccination>6 months before surgery,undergoing surgery within 4 weeks of diagnosis of COVID-19 breakthrough infection,operation duration of 4 h or longer,cancer-related surgery,and major surgical procedures were significantly linked to a CCI>20.9.A nomogram model was constructed utilizing CCI>20.9 in the training cohort[area under the curve(AUC):0.919,95%confidence interval(CI):0.881–0.957],the internal validation cohort(AUC:0.910,95%CI:0.847–0.973),and the external validation cohort(AUC:0.841,95%CI:0.799–0.883).The calibration curve for the probability of CCI>20.9 demonstrated good agreement between the predictions made by the nomogram and the actual observations.Conclusions:The developed model holds significant potential in aiding clinicians with clinical decisionmaking and risk stratification for patients who have experienced breakthrough infection of COVID-19 prior to undergoing elective hepato-pancreato-biliary surgery.展开更多
[Objectives]To treat patients with Lower-Jiao Obstruction Syndrome caused by severe pneumonia complicated with heart failure using the retention enema with Modified Dahuang Mudan Decoction,and to observe the effect an...[Objectives]To treat patients with Lower-Jiao Obstruction Syndrome caused by severe pneumonia complicated with heart failure using the retention enema with Modified Dahuang Mudan Decoction,and to observe the effect and safety of this treatment on inflammatory indicators,cardiac function,gastrointestinal function and multiple organ failure in patients with Lower-Jiao(lower energizer)Obstruction Syndrome caused by severe pneumonia complicated with heart failure.[Methods]54 patients with Lower-Jiao Obstruction Syndrome caused by severe pneumonia complicated with heart failure diagnosed in Nanchong Chinese Medicine Hospital from January 2020 to December 2021 were randomly divided into experimental group(n=27)and control group(n=27).The control group was given conventional treatment combined with 0.9%sodium chloride injection(100 mL)+glycerine enema(40 mL).The treatment group was treated with Modified Dahuang Mudan Decoction on the basis of conventional treatment for 7 d.The efficacy indicators and adverse events such as white blood count(WBC),C-reactive protein(CRP),procalcitonin(PCT),N-terminal pro-brain natriuretic peptide(NT-proBNP),Lausanne Intestinal Failure Estimation(LIFE)and multiple organ dysfunction score(MODS)were observed.[Results](i)There was no significant difference in WBC,PCT,CRP and NT-proBNP between the two groups before treatment.All indicators after treatment were significantly lower than those before treatment in both groups(P<0.05).The levels of WBC,PCT and CRP in the treatment group were lower than those in the control group after treatment(P<0.05),and there was no significant difference in NT-proBNP between the two groups after treatment(P>0.05),but the difference in NT-proBNP before and after treatment in the treatment group was higher than that in the control group.(ii)The LIFE of the two groups decreased significantly after treatment,and the improvement of LIFE of the treatment group was better than that of the control group(P<0.05).(iii)The MODS of the two groups decreased significantly after treatment(P<0.05),and the degree of decrease after treatment in the treatment group was higher than that in the control group(P<0.05).(iv)There was no significant difference in all-cause mortality between the two groups(P>0.05).(v)No serious adverse events were found in both groups during the treatment period.[Conclusions]The conventional treatment,combined with the retention enema with Modified Dahuang Mudan Decoction could further reduce the inflammatory indicators,improve cardiac function,improve intestinal function and organ function,and the safety was good.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:Co-infection with both Plasmodium and dengue virus(DENV)infectious species could have serious and fatal outcomes if left undiagnosed and without timely treatment.The present study aimed to determine the poo...Background:Co-infection with both Plasmodium and dengue virus(DENV)infectious species could have serious and fatal outcomes if left undiagnosed and without timely treatment.The present study aimed to determine the pooled prevalence estimate of severe malaria among patients with co-infection,the risk of severe diseases due to co-infection,and to describe the complications of severe malaria and severe dengue among patients with coinfection.Methods:Relevant studies published between databases between 12 September 1970 and 22 May 2020 were identified and retrieved through a search of the ISI Web of Science,Scopus,and MEDLINE.The pooled prevalence and 95%confidence interval(CI)of severe malaria among patients with Plasmodium and DENV co-infection was estimated with a random-effects model to take into account the between-study heterogeneity of the included studies.The risks of severe malaria and severe diseases due to co-infection were estimated with the pooled odds ratio(OR)and 95%CI with a random-effects model.Results:Of the 5653 articles screened,13 studies were included in the systematic review and meta-analysis.The results demonstrated that the pooled prevalence estimate of severe malaria among patients with co-infection was 32%(95%CI:18-47%,I 2=92.3%).Patients with co-infection had a higher risk of severe diseases than those with DENV mono-infection(odds ratio[OR]=3.94,95%CI:1.96-7.95,I 2=72%).Patients with co-infection had a higher risk of severe dengue than those with DENV mono-infection(OR=1.98,95%CI:1.08-3.63,I 2=69%).The most severe complications found in severe dengue were bleeding(39.6%),jaundice(19.8%),and shock/hypotension(17.9%),while the most severe complications found in severe malaria were severe bleeding/bleeding(47.9%),jaundice(32.2%),and impaired consciousness(7.43%).Conclusions:The present study found that there was a high prevalence of severe malaria among patients with Plasmodium and DENV co-infection.Physicians in endemic areas where these two diseases overlap should recognize that patients with this co-infection can develop either severe malaria or severe dengue with bleeding complications,but a greater risk of developing severe dengue than severe malaria was noted in patients with this co-infection.Trial registration:The protocol of this study was registered at PROSPERO:CRD42020196792.展开更多
基金supported by grants from the Science Fund for Creative Research Groups of the National Natural Science Founda-tion of China(81521091 and 82073031)the National Natural Sci-ence Foundation of China(92269204)Clinical Research Plan of SHDC(SHDC2020CR5007 and SHDC22020213)。
文摘Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary surgery subsequent to experiencing breakthrough infection of coronavirus disease 2019(COVID-19).This study aimed to find factors predicting postoperative complications and construct an innovative nomogram to pinpoint patients who were susceptible to developing severe complications following breakthrough infection of COVID-19 after undergoing elective hepato-pancreato-biliary surgery.Methods:This multicenter retrospective cohort study included consecutive patients who underwent elective hepato-pancreato-biliary surgeries between January 3 and April 1,2023 from four hospitals in China.All of these patients had experienced breakthrough infection of COVID-19 prior to their surgeries.Additionally,two groups of patients without preoperative COVID-19 infection were included as comparative controls.Surgical complications were meticulously documented and evaluated using the comprehensive complication index(CCI),which ranged from 0(uneventful course)to 100(death).A CCI value of 20.9 was identified as the threshold for defining severe complications.Results:Among 2636 patients who were included in this study,873 were included in the reference group I,941 in the reference group II,389 in the internal cohort,and 433 in the external validation cohort.Multivariate logistic regression analysis revealed that completing a full course of COVID-19 vaccination>6 months before surgery,undergoing surgery within 4 weeks of diagnosis of COVID-19 breakthrough infection,operation duration of 4 h or longer,cancer-related surgery,and major surgical procedures were significantly linked to a CCI>20.9.A nomogram model was constructed utilizing CCI>20.9 in the training cohort[area under the curve(AUC):0.919,95%confidence interval(CI):0.881–0.957],the internal validation cohort(AUC:0.910,95%CI:0.847–0.973),and the external validation cohort(AUC:0.841,95%CI:0.799–0.883).The calibration curve for the probability of CCI>20.9 demonstrated good agreement between the predictions made by the nomogram and the actual observations.Conclusions:The developed model holds significant potential in aiding clinicians with clinical decisionmaking and risk stratification for patients who have experienced breakthrough infection of COVID-19 prior to undergoing elective hepato-pancreato-biliary surgery.
基金Supported by Sichuan Science and Technology Plan Project-Key R&D Project(2022YFS0410)Nanchong R&D Funding Project(19YFZJ0005)Science and Technology Research Project of Sichuan Provincial Administration of Chinese Medicine(2020LC0150)。
文摘[Objectives]To treat patients with Lower-Jiao Obstruction Syndrome caused by severe pneumonia complicated with heart failure using the retention enema with Modified Dahuang Mudan Decoction,and to observe the effect and safety of this treatment on inflammatory indicators,cardiac function,gastrointestinal function and multiple organ failure in patients with Lower-Jiao(lower energizer)Obstruction Syndrome caused by severe pneumonia complicated with heart failure.[Methods]54 patients with Lower-Jiao Obstruction Syndrome caused by severe pneumonia complicated with heart failure diagnosed in Nanchong Chinese Medicine Hospital from January 2020 to December 2021 were randomly divided into experimental group(n=27)and control group(n=27).The control group was given conventional treatment combined with 0.9%sodium chloride injection(100 mL)+glycerine enema(40 mL).The treatment group was treated with Modified Dahuang Mudan Decoction on the basis of conventional treatment for 7 d.The efficacy indicators and adverse events such as white blood count(WBC),C-reactive protein(CRP),procalcitonin(PCT),N-terminal pro-brain natriuretic peptide(NT-proBNP),Lausanne Intestinal Failure Estimation(LIFE)and multiple organ dysfunction score(MODS)were observed.[Results](i)There was no significant difference in WBC,PCT,CRP and NT-proBNP between the two groups before treatment.All indicators after treatment were significantly lower than those before treatment in both groups(P<0.05).The levels of WBC,PCT and CRP in the treatment group were lower than those in the control group after treatment(P<0.05),and there was no significant difference in NT-proBNP between the two groups after treatment(P>0.05),but the difference in NT-proBNP before and after treatment in the treatment group was higher than that in the control group.(ii)The LIFE of the two groups decreased significantly after treatment,and the improvement of LIFE of the treatment group was better than that of the control group(P<0.05).(iii)The MODS of the two groups decreased significantly after treatment(P<0.05),and the degree of decrease after treatment in the treatment group was higher than that in the control group(P<0.05).(iv)There was no significant difference in all-cause mortality between the two groups(P>0.05).(v)No serious adverse events were found in both groups during the treatment period.[Conclusions]The conventional treatment,combined with the retention enema with Modified Dahuang Mudan Decoction could further reduce the inflammatory indicators,improve cardiac function,improve intestinal function and organ function,and the safety was good.
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.
文摘Background:Co-infection with both Plasmodium and dengue virus(DENV)infectious species could have serious and fatal outcomes if left undiagnosed and without timely treatment.The present study aimed to determine the pooled prevalence estimate of severe malaria among patients with co-infection,the risk of severe diseases due to co-infection,and to describe the complications of severe malaria and severe dengue among patients with coinfection.Methods:Relevant studies published between databases between 12 September 1970 and 22 May 2020 were identified and retrieved through a search of the ISI Web of Science,Scopus,and MEDLINE.The pooled prevalence and 95%confidence interval(CI)of severe malaria among patients with Plasmodium and DENV co-infection was estimated with a random-effects model to take into account the between-study heterogeneity of the included studies.The risks of severe malaria and severe diseases due to co-infection were estimated with the pooled odds ratio(OR)and 95%CI with a random-effects model.Results:Of the 5653 articles screened,13 studies were included in the systematic review and meta-analysis.The results demonstrated that the pooled prevalence estimate of severe malaria among patients with co-infection was 32%(95%CI:18-47%,I 2=92.3%).Patients with co-infection had a higher risk of severe diseases than those with DENV mono-infection(odds ratio[OR]=3.94,95%CI:1.96-7.95,I 2=72%).Patients with co-infection had a higher risk of severe dengue than those with DENV mono-infection(OR=1.98,95%CI:1.08-3.63,I 2=69%).The most severe complications found in severe dengue were bleeding(39.6%),jaundice(19.8%),and shock/hypotension(17.9%),while the most severe complications found in severe malaria were severe bleeding/bleeding(47.9%),jaundice(32.2%),and impaired consciousness(7.43%).Conclusions:The present study found that there was a high prevalence of severe malaria among patients with Plasmodium and DENV co-infection.Physicians in endemic areas where these two diseases overlap should recognize that patients with this co-infection can develop either severe malaria or severe dengue with bleeding complications,but a greater risk of developing severe dengue than severe malaria was noted in patients with this co-infection.Trial registration:The protocol of this study was registered at PROSPERO:CRD42020196792.
