Showing papers by "Sichuan University published in 1969"

Treatment of spontaneous ruptured hepatocellular carcinoma: A single-center study.

Abstract: Objectives: Spontaneous rupture of hepatocarcinoma (HCC) is a fatal complication of advanced HCC and is associated with poor prognosis. However, there is no consensus on the best approach to treat hemoperitoneum due to ruptured HCC. In this paper, we evaluate and discuss the outcomes of different treatment methods employed at our center for ruptured HCC. Methods: We reviewed the medical records of 132 patients diagnosed with ruptured HCC at our hospital from January 2003 to December 2012 and evaluated and compared the outcomes of five treatment methods for ruptured HCC: conservative treatment, surgical hemostasis, transarterial embolization (TAE), and oneand two-stage resections. Results: There was no significant difference in the median survival time between the conservative treatment and surgical hemostasis groups. Patients in the TAE alone group had a better prognosis than those in the conservative treatment and surgical hemostasis groups. The survival time of the tumor resection group was obviously better than that of the conservative treatment, surgical hemostasis, and TAE alone groups, but no significant difference was observed between the one-stage and two-stage resection groups. Conclusions: One-stage hepatectomy is a better option for patients with preserved liver function, whereas TAE is a better option for those with poorly preserved liver function.

Bisphosphonates can prevent recurrent hip fracture and reduce the mortality in osteoporotic patient with hip fracture: A meta-analysis.

Abstract: OBJECTIVE This meta-analysis was conducted to investigate the efficacy of bisphosphonates for preventing recurrent hip fracture and reducing the mortality of elderly patient with hip fracture. METHODS The databases of Pubmed, Embase and Cochrane Library were searched. All randomized or prospective matched controlled trials that assessed the efficacy of bisphosphonate for elderly patients with hip fracture were included. Two researchers independently extracted data of the included articles and assessed the methodological quality which was assessed based on Jadad scoring system or Newcastle-Ottawa scale. The second hip fracture incidence, mortality and complications were compared between bisphosphonates and control groups. RESULTS Four studies including 3088 patients were included. Results showed that there were significant difference of second hip fracture (P<0.05) and mortality (P<0.05) between bisphosphonates group and control group. While no significant intergroup difference were observed for all complications. CONCLUSIONS Bisphosphonates can prevent subsequent hip fracture, reduce the mortality, and does not increase the overall complications in elderly patients with hip fracture.

Clinical comparison of propofol-remifentanil TCI with sevoflurane induction/maintenance anesthesia in laparoscopic cholecystectomy.

Abstract: UNLABELLED Objective : We aimed to compare the anesthetic characteristics between total intravenous anesthesia (TIVA) using propofol-remifentanil with target control infusion (TCI) and volatile induction and maintenance anesthesia (VIMA) using sevoflurane and sufentanyl for patients undergoing laparoscopic cholecystectomy. METHODS A total of 120 patients undergoing laparoscopic cholecystectomy were randomly assigned to two groups. Patients in group T received TCI of propofol-remifentanil for induction and maintenance. Patients in group S received sevoflurane-sufentanyl for induction and maintenance. RESULTS Patients in group S had a significantly faster induction time than patients in group T (109s vs.44s). The emergence time in terms of time to extubation was comparable between the two groups, while the time to eyes opening (419s vs.483s, p=0.006) and duration in PACU were longer in group S (44 min vs.53 min, p=0.017). Ten (17.2%) patients in group S were administered an antihypertensive drug when gallbladder issues were present, while only 1(1.7%) patient needed this drug in group T (p=0.004).More patients in group T than in group S received fentanyl for analgesia in PACU (88%vs.70%, p=0.013). The incidence of postoperative nausea and vomiting (PONV) in PACU was higher in group S than in group T (20% vs.38%, p=0.027). CONCLUSION Both techniques had advantages and disadvantages in laparoscopic cholecystectomy; none of the techniques studied was superior.

Single-dose sufentanil or fentanyl reduces agitation after sevoflurane anesthesia in children undergoing ophthalmic surgery

Abstract: Objectives: The trail investigated the effect of small dose sufentanil or fentanyl administrated before the end of surgery in reducing the incidence of emergence agitation after anesthesia with sevoflurane in preschool children undergoing ophthalmology surgery, and the incidence of emergence agitation of sevoflurane anesthesia. Methods: From September 2011 to January 2012 January, ninety ASA I-II children, aged from 3-7 years, undergoing ophthalmology surgery in West China Hospital, were randomly assigned to three groups to receive intravenous saline, sufentanil 0.1μg/kg or fentanyl 1μg/kg at 20 minutes before the end of the surgery. Children were scored by scoring system for emergence agitation (SSEA), Children’s and Infants’ Postoperative Pain Scale (CHIPPS) score. Results: The incidence of agitation was 30% in sufentanil group, 36.67% in fentanyl group, and 63.33% in control group. The incidence of sever agitation (SSEA score≥3) was 6.67% in sufentanil group, 23.37% in fentanyl group, and 36.67% in control group. The agitation and pain scores in sufentanil group and fentanyl group were better than those in control group (P < 0.05). There was no difference among three groups about time to extubation. Conclusions: We conclude that the incidence of emergence agitation after sevoflurane anesthesia in children undergoing ophthalmology surgery is up to 63.33%. The single dose of sufentanil or fentanyl can reduce the emergence agitation in children anesthesized with sevoflurane, with no adverse effects. The effect of sufentanil is better than fentanyl.

Increased frequencies of Th17 in the peripheral blood of patients with chronic lymphocytic leukemia: A one year follow-up.

Abstract: UNLABELLED Objective : In this study, we aimed to investigate changes of peripheral Th17 and Treg cells frequencies in the newly-diagnosed Chronic Lymphocytic Leukemia (CLL) patients for 12 months Methods : In this research, 50 CLL patients were enrolled Circulating Th1, Th17 cells and CD4+CD25+Foxp3+Treg cells were analyzed by flow cytometry Plasma levels of related cytokines were detected by enzyme-linked immuno sorbent assay (ELISA) The study was carried out from January 2012 to October 2013 at Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, PR China RESULTS Compared with healthy controls, Th17 cells related cytokines were significantly increased in CLL patients, while Treg cells related cytokines were significantly lowered In the follow-up, we found that the frequency of Treg cells was irregular, while the frequency of Th17 cells was gradually decreased CONCLUSION Our study suggested that Th17 cells may play important role in the immune regulation of CLL, and may become a new target in CLL therapy

Comparison of liver resection and transplantation for Child-pugh A cirrhotic patient with very early hepatocellular carcinoma and portal hypertension

Abstract: Objective: The aim of this study was to compare the outcomes of liver transplantation and resection for very early hepatocellular carcinoma (HCC, ≤ 2 cm) patients with Child-pugh A liver function and portal hypertension. Methods: From 2008 to 2013, 38 patients with Child-pugh class A liver function and portal hypertension were diagnosed as very early HCC, of whom 13 patients who received liver transplantation and 25 patients underwent liver resection. We compared the preoperative characteristics, recurrence-free survival (RFS) and overall survival (OS) rates of two group. Results: The baseline characteristics of two groups were similar. No perioperative mortality and liver failure were observed in both groups. The 1-, 3- and 5-year RFS rates of patients received liver resection and liver transplantation were 92.3%, 92.3% 92.3% and 92.0%, 71.7% and 64.5% respectively (P=0.140). The 1-, 3- and 5-year OS rates of two groups were also similar (100%, 91.7% and 91.7% for group T versus 100%, 93.3% and 93.3% for group R, P=0.695). Conclusion: Liver resection can offer satisfactory outcomes for very early HCC patients with well liver function and portal hypertension and should be considered as the first line choice for selected patients.

Early stage effect of ischemic preconditioning for patients undergoing on-pump coronary artery bypass grafts surgery: systematic review and meta-analysis.

Abstract: Background: During the on-pump coronary artery bypass grafts surgery, ischemia/reperfusion injury would happen. Ischemia preconditioning could increase the tolerance against subsequent ischemia and reduce the ischemia/reperfusion injury. However the clinical outcomes of the available trials were different. Methods: We searched the Cochrane Central Register of Controlled Trials on The Cochrane Library (Issue 3, 2013), the Medline/PubMed and CNKI in March 2013. RevMan 5.1.6 and GRADEprofiler 3.6 were used for statistical analysis and evidence quality assessment. Heterogeneity was evaluated with significance set at P ≤ 0.10. Results: Eighteen randomized controlled trials were included. There were no differences on in-hospital mortality, postoperative myocardial infarction morbidity between ischemia preconditioning and control groups. The heterogeneity of creatine kinase-MB level 24 hours after surgery was obvious. The differences of 72 hours area under the curve of cardiac troponin T (mean differences of -14.50, 95% confidence interval of -21.71 to -7.28) and troponin I (mean differences -181.79, 95% confidence interval of -270.07 to -93.52) after surgery were observed. Conclusions: All the 18 trails, the positive and the negative results were equal. The meta-analysis results should be interpreted with caution due to limited effective data. Because of high cost-effectiveness, ischemia preconditioning could not be denied completely. Large-scale randomized studies are needed, with the operation procedures and included criteria being more specific.

Hereditary angioedema: A rare cause of recurrent abdominal pain.

Abstract: Hereditary angioedema is a rare autosomal dominant inherited disease which is characterized by an episodic, self-limiting increase in vascular permeability. Symptoms commonly involve in nonpitting, nonpruritic skin swellings. We present a case of hereditary angioedema. The patinets complained of a recurrent abdominal pain without accompanying skin swelling whose diagnosis was delayed nearly 20 years and accepted an unnecessary surgery. According to the decreased serum C1-inhibitor and C4 concentration, the patient was finally diagnosed with hereditary angioedema type I. After treatment with danazole, the patient reported a significant decrease in the frequency of attacks and the severity of pain. HAE is a rare cause of abdominal pain, however it needs to be taken as one of the differential diagnosis of various acute abdomens in order to avoid unnecessary surgeries.

Development and validation of a convenient formula evaluating the value and applicability of medical literature in clinical practice.

Abstract: Objective: Evidence-based medicine offers explicit methods to evaluate the evidence grades of literature. However, evidence grades do not meet all the practical needs of physicians. This study is aimed to develop a convenient method for evaluating the clinical value of medical literature from the perspective of the clinician. Methods: A literature applicability equation was formulated through the Delphi method and the analytic hierarchy process. A consistency check was used to ascertain the efficacy of the formula. Three senior clinicians assessed 30 articles based on their clinical experiences and subjective opinions, while one independent researcher performed independent assessments of the applicability of 30 articles using the evaluation formula. Results: The literature applicability equation was Y = 3.93X 1 + 11.78X 2 + 14.83X 3 + 44.53X 4 + 24.93X 5 , where Y = literature applicability, X 1 = years since publication, X 2 = target question covered or not, X 3 = sample size, X 4 = study type, and X 5 = journal quality. Consistency index (CI) values for the first-level indicator (“literature applicability”) and the second-level indicators (“pertinence and timeliness” and “quality of results”) were 0.0325, 0.0012, and 0.0001, respectively. The weights used to calculate the matrix indicators had satisfactory accordance (random coincidence coefficient = 0.056). A consistency check for the efficacy of the formula revealed kappa = 0.749 and P < .001. Conclusion: The developed and validated literature applicability evaluation formula may be a useful and convenient tool for identifying clinically valuable medical literature.