ObjectiveTo evaluate the safety and feasibility of non-nasogastric tube throughout the perioperative period of classical Whipple pancreaticoduodenectomy. MethodsA retrospective analysis was conducted on the clinical data of 63 patients who underwent Whipple pancreaticoduodenectomy at West China Hospital of Sichuan University from June 2020 to August 2023. According to whether nasogastric tube was placed throughout the perioperative period, the patients were divided into nasogastric tube group (NGT group, n=32) and no nasogastric tube group (no NGT group, n=31). The intraoperative indicators such as gastrointestinal anastomosis mode and outcome measures such as postoperative hospital stay were compared between the two groups. Results① Preoperative baseline data: the proportion of benign diseases (P=0.005) and preoperative pancreatitis (P=0.003) of the no NGT group were higher than those of the NGT group, and other preoperative baseline data, such as age and sex, were not statistically significant (P>0.05). ② Intraoperative index: the proportion of circular stapler (P=0.009) was smaller and the operation time was shorter (P<0.001), but there was no significant difference in the anastomosis, intraoperative blood transfusion and intraoperative bleeding (P>0.05). ③ Postoperative outcome measures: the postoperative length of hospital stay (P<0.001) and the incidence of delayed gastric emptying (P<0.001) of the no NGT group were lower than those in the NGT group, but the postoperative time of food intake, incidence of pancreatic fistula, incidence of postoperative bleeding, and Clavien-Dindo grade of complications were not significant (P>0.05), and on one died within 30 d after operation. ConclusionsThe results of this study preliminarily show that, it is safe and feasible not to place nasogastric tubes throughout the perioperativeperiod in patients undergoing classical Whipple pancreaticoduodenectomy. Compared with placing nasogastric tube, it can shorten the postoperative hospital stay, reduce the incidence of postoperative delayed gastric emptying.
Diagnosis and surgical procedures were studied in this paper. Twentyfive cases of insulinoma were treated surgically from 1970 to 1997, in which 10 patients had Whipple′s triad so that the early diagnosis could be made. The sites of tumours were found in 10 out of 12 undergoing. Selective celiac angiongraphy with the accuracy rate of 83%, but B-ultrasonography and CT gave only 10% (4 out of 25) and 40%(8 out of 20) respectively. In this series, 5 cases underwent bodytail pancreatectomy and 20 cases enucleation of insulinoma. Blood glucose levels were tested during operation in 15 cases, and they all reached the normal level one hour after the tumours were completely removed. The authors consider that Whipple′s triad is the main basis in diagnosis of insulinoma. The selective celiac angiongraphy play an important role in detecting and locating the tumour. If diagnosis is made, surgical operation should be taken. The blood glucose monitoring during operation is the hallmark for complete resection of insulinomas.
ObjectiveTo compare the clinical effects of enteral nutrition via stoma of jejunum or nasal-jejunum tube after Whipple procedure. MethodsEighty-seven patients performed Whipple procedure were divided into nasaljejunum tube group(n=47)and stoma of jejunum group(n=40)according to the different enteral nutrition methods. The adverse reactions such as vomiting, abdominal distension, pharyngeal pain, and hypostatic pneumonia, anastomotic leakage, hospital stay, hospitalization expenses, and serum glucose and electrolyte(CL-, Na+, K+)on day 1, 3, 5 after operation were compared between two groups. ResultsCompared with the nasal-jejunum tube group, the rates of adverse reactions and hypostatic pneumonia were more lower(P < 0.05), the hospitalization expense was more less (P < 0.05) in the nasal-jejunum tube group. The rate of anastomotic leakage and hospital stay had no significant differences between the nasal-jejunum tube group and stoma of jejunum group(P > 0.05). The differences of serum glucose and electrolyte(CL-, Na+, K+)on day 1, 3, 5 after operation were not statistically significant between two groups(P > 0.05). ConclusionsEnteral nutrition via the stoma of jejunum after Whipple procedure has some better clinical effects in reducing adverse reactions such as vomiting, abdominal distension, pharyngeal pain, hypostatic pneumonia. The hospitalization expenses are decreased. There are no obvious effects on the hospital stay, blood glucose and electrolyte concentration on day 1, 3, 5 after operation.
Antimicrobial stewardship (AMS) is an important means to control bacterial resistance. The unique situation of intensive care unit (ICU) poses a challenge to AMS. This article reviews the literature on AMS in the ICU at home and abroad in recent years, and summarizes the related measures of AMS. Effective AMS measures in the ICU include setting up a multidisciplinary AMS team, using rapid microbial diagnosis technology to shorten the time of diagnosis, using non-culture methods to assess the necessity of antimicrobial therapy for patients with suspected sepsis, and evaluating the effectiveness of antimicrobial therapy as early as possible and optimizing it. These initiatives aim to increase the rational use of antimicrobials in ICU, reduce the risk of multidrug-resistant infections, and improve patients’ condition.
The teaching team of the Department of Laboratory Medicine, West China School of Medicine, Sichuan University takes scientific spirit, craftsmanship spirit, and medical humanities spirit as the goal, combines the core knowledge of clinical microbiology laboratory technology course with cases of coronavirus disease 2019 prevention and control, drug resistance monitoring, and scientists’ deeds, and adopts strategies such as hot debate and special report to achieve the integration of knowledge and value. The actual effectiveness of this model has been verified through the assessment of students’ abilities and values. This article introduces the course-based ideological and political education construction mentioned above, aiming to explore the integration path of course-based ideological and political education in the clinical microbiology laboratory technology, and construct a new teaching model that combines professional competence and value guidance.
The rotation center of traditional hip disarticulation prosthesis is often placed in the front and lower part of the socket, which is asymmetric with the rotation center of the healthy hip joint, resulting in poor symmetry between the prosthesis movement and the healthy lower limb movement. Besides, most of the prosthesis are passive joints, which need to rely on the amputee’s compensatory hip lifting movement to realize the prosthesis movement, and the same walking movement needs to consume 2–3 times of energy compared with normal people. This paper presents a dynamic hip disarticulation prosthesis (HDPs) based on remote center of mechanism (RCM). Using the double parallelogram design method, taking the minimum size of the mechanism as the objective, the genetic algorithm was used to optimize the size, and the rotation center of the prosthesis was symmetrical with the rotation center of the healthy lower limb. By analyzing the relationship between the torque and angle of hip joint in the process of human walking, the control system mirrored the motion parameters of the lower on the healthy side, and used the parallel drive system to provide assistance for the prosthesis. Based on the established virtual prototype simulation platform of solid works and Adams, the motion simulation of hip disarticulation prosthesis was carried out and the change curve was obtained. Through quantitative comparison with healthy lower limb and traditional prosthesis, the scientificity of the design scheme was analyzed. The results show that the design can achieve the desired effect, and the design scheme is feasible.
ObjectiveTo explore the clinical outcomes of acetabular revision using a metal reconstruction cage. MethodsBetween October 2006 and October 2013, 16 patients (16 hips) underwent acetabular revision with a metal reconstruction cage. There were 4 males and 12 females, with the mean age of 62.7 years (range, 49-78 years). The time from total hip arthroplasty to revision was 3-15 years (mean, 8.2 years). The causes for revision were aseptic acetabular loosening in 15 cases, and femoral periprosthetic fracture (Vancouver type B3) in 1 case. According to the American Academy of Orthopaedic Surgeons (AAOS) classification, there were 12 cases of type III and 4 cases of type IV; according to the Paprosky classification, there were 12 cases of type IIIA and 4 cases of type IIIB. Harris score was used for hip function evaluation, and visual analogue scale (VAS) for pain in the thigh. X-ray films were taken for imaging evaluation. ResultsHealing of incision by first intention was obtained in all patients. Deep venous thrombosis occurred in 1 patient, and was cured after anticoagulation therapy. No complications of infection, neurovascular injury, and prosthetic dislocation were found. Sixteen patients were followed up 6.8 years on average (range, 2-9 years). The Harris score was significantly increased from preoperative 42.44±4.66 to 91.88±3.28 at last follow-up (t=–106.30, P=0.00). Two patients had mild pain in the thigh, but pain disappeared at 1 year after operation. At immediate after operation, the abduction angle was 37-54° (mean, 42.9°). The distance between acetabular rotation centre and teardrop line was (33.67±12.19) mm for preoperative value and was (20.67±9.63) mm for postoperative value, showing significant difference (t=–9.60, P=0.00). The distance between acetabular rotation centre and lateral teardrop was (34.98±12.30) mm for preoperative value and was (40.04±6.61) mm for postoperative value, showing significant difference (t=–3.15, P=0.00). X-ray film results showed bony fusion at the osteotomy sites at 4 to 12 months after operation. No continuous radiolucent line, prosthetic dislocation, or osteolysis was found, and bony ingrowth was observed in all patients. No patient received re-revision due to prosthetic loosening. ConclusionThe metal reconstruction cage for acetabular revision can achieve good effectiveness for patients with serious bone defect.
Objective To study the effect of simultaneous bilateral total hip arthroplasty in a single procedure. Methods From October 1999 to March 2004, 15 patients (30 hips) underwent simultaneous sequential bilateral total hip arthroplasty (THAs) in a single procedure. Of the 15 patients, 11 were male (22 hips) and 4 were female (8 hips). Their ages ranged from 35 to 70 years. Their courses of disease ranged from 1 year to 50 years (4.8 years on average). The Harris scores of the joint function before the operation ranged from 12 to 45 points (27 points on average). Five were done with Smith-Peterson and 10 were done with Moore. Results The operative time was 3 hours and 25 minutes to 5 hours (4 hours and 10 minutes on average). The volume of blood transfusion during operation was 400 to 2 400 ml (1 160 mlon average). All the 15 patients were followed up for 3 to 35 months (18 monthson average). The Harris scores of the joint function after the operation rangedfrom 70 to 100 points (86 points on average). There was significant difference in the scores between before and after operations (Plt;0.05). There was only 1death within 1 months of the operation and no serious between complications such as infection, pulmonary embolism, and deep vein plug. All the patients were still ambulant in the community and gained significant pain relief. Conclusion Simultaneous bilateral total hip arthroplasty in a single procedure is a safe and effective method. However, the decision of performing singlestage bilateral total hip arthroplasty should be carefully made and preoperative preparation should be sufficiently made.
Pulse waves contain rich physiological and pathological information of the human vascular system. The pulse wave diagnosis systems are very helpful for the clinical diagnosis and treatment of cardiovascular diseases. Accurate pulse waveform is necessary to evaluate the performances of the pulse wave equipment. However, it is difficult to obtain accurate pulse waveform due to several kinds of physiological and pathological conditions for testing and maintaining the pulse wave acquisition devices. A pulse wave generator was designed and implemented in the present study for this application. The blood flow in the vessel was simulated by modeling the cardiovascular system with windkessel model. Pulse waves can be generated based on the vascular systems with four kinds of resistance. Some functional models such as setting up noise types and signal noise ratio (SNR) values were also added in the designed generator. With the need of portability, high speed dynamic response, scalability and low power consumption for the system, field programmable gate array (FPGA) was chosen as hardware platform, and almost all the works, such as developing an algorithm for pulse waveform and interfacing with memory and liquid crystal display (LCD), were implemented under the flow of system on a programmable chip (SOPC) development. When users input in the key parameters through LCD and touch screen, the corresponding pulse wave will be displayed on the LCD and the desired pulse waveform can be accessed from the analog output channel as well. The structure of the designed pulse wave generator is simple and it can provide accurate solutions for studying and teaching pulse waves and the detection of the equipments for acquisition and diagnosis of pulse wave.
ObjectiveTo investigate the effectiveness of multidisciplinary doctor-nurse collaboration team on the perioperation management of geriatric patients with hip fractures.MethodsThe clinical data of 489 geriatric patients with hip fractures (femoral neck fracture and intertrochanteric fracture) between January 1st 2016 and January 1st 2018 was retrospectively analyzed. Among them, 279 patients were treated with the multidisciplinary doctor-nurse collaboration care (observation group) and 210 patients were treated with the conventional therapeutics and nursing care (control group). There was no significant difference in gender, age, cause of injury, type and classification of fracture, the interval between injury and admission, and Charlson index between the two groups (P>0.05). The surgery rates, time from hospitalization to operation, length of stay, and the incidences of perioperative complications were compared between the two groups.ResultsThe surgery rate was 90.32% (252/279) in observation group and 80.48% (169/210) in control group, showing significant difference between the two groups (χ2=9.703, P=0.002). The time from hospitalization to operation and length of stay in observation group [(5.39±2.47), (10.56±3.76) days] were significant shorter than those in control group [(6.13±2.79), (12.27±3.11) days] (t=−3.075, P=0.002; t=−5.330, P=0.000). The incidence of respiratory complications was 46.15% in control group and 30.56% in observation group; the incidence of cardiovascular system complications was 69.23% in control group and 51.19% in observation group; the incidence of cerebrovascular system complications was 20.12% in control group and 11.11% in observation group; the incidence of deep venous thrombosis was 40.24% in control group and 25.40% in observation group. The incidences of perioperative complications were significantly lower in observation group than in control group (P<0.05).ConclusionMultidisciplinary doctor-nurse collaboration team is conducive not only to improve the surgery rates, but also to reduce perioperative complications as well as shorten the length of stay and preoperative waiting time.