简介：Itisveryimportanttomaintainthelevelofmeanarterialpressure(MAP).TheMAPcontrolisappliedinmanyclinicalsituations,includinglimitingbleedingduringcardiacsurgeryandpromotinghealingforpatient'spost-surgery.Thispaperpresentsafuzzycontroller-basedmultiple-modeladaptivecontrolsystemforpostoperativebloodpressuremanagement.Multiple-modeladaptivecontrol(MMAC)algorithmisusedtoidentifythepatientmodel,anditisafeasiblesystemidentificationmethodeveninthepresenceoflargenoise.Fuzzycontrol(FC)methodisusedtodesigncontrollerbank.Eachfuzzycontrollerinthecontrollerbankisinfactanonlinearproportional-integral(PI)controller,whoseproportionalgainandintegralgainareadjustedcontinuouslyaccordingtoerrorandrateofchangeoferroroftheplantoutput,resultinginbetterdynamicandstablecontrolperformancethantheregularPIcontroller,especiallywhenanonlinearprocessisinvolved.Fordemonstration,anonlinear,pulsatile-flowpatientmodelisusedforsimulation,andtheresultsshowthattheadaptivecontrolsystemcaneffectivelyhandlethechangesinpatient'sdynamicsandprovidesatisfactoryperformanceinregulationofbloodpressureofhypertensionpatients.

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简介：Treated58patients(32malesand26females)withpostoperativeuroschesisbyacupuncture.Therapeuticresultswereexcellentin33cases,goodin22cases,andineffectivein3cases.

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简介：目的：观察推拿治疗手术后尿潴留的临床疗效。方法：对37例手术后尿潴留患者施行穴位推拿治疗，穴位选用气海、关元、中极，双侧三阴交。结果：治疗1～3次后，治愈36例，1例因退出治疗而未统计疗效。结论：穴位推拿是治疗手术后尿潴留的一种有效方法。

简介：BackgroundPostoperativewoundinfectionwasfrequentlyreportedinpatientsundergoingheartvalvereplacementandcoronaryarterybypasssurgery(CABG)duetomajortrauma,long-termbedrest,malnutritionandcompromisedimmunesystem.Infectedpatientswereusuallyhousedinthesameairborneinfectionisolationrooms.Aseriesofairmonitoringandcontrolstrategiesshouldbestrictlyenforcedtoaimatavoidingairbornefungalcontaminationandachievinghighercurerateininfectedpatients.TheefficacyofAirinspaceplasmairsysteminreducingairbornefungalcontaminationincardiacpostoperativeinfectionwardshasnotbeenclearlydetermined.MethodsAsurveyofaircontaminationwasconductedinthecardiacpostoperativeinfectionwardusingAirinspaceplasmairsystem.Laserparticlecounterwasusedtodeterminetheairborneparticlesof0.3μm?and0.5μm?insize.Airsampleswereincubatedandexaminedforfungaldevelopment.AirborneparticlecountsandfungalloadsofairsamplescollectedbeforeandaftertreatmentwithAirinspaceplasmairsystemwerecompared.ResultsTheparticlecountsin0.3μmrangecollectedbefore(52206<2345)andafter(9408<4317)treatedwithAirinspaceplasmairsystemdifferedsignificantly(P<0.01).Theparticlecountsin0.5μmrangebefore(12995<422)andafter(2016<915)treatmentwithAirinspaceplasmairsystemalsodifferedsignificantly(P<0.01).ThefungalloadsbeforeandafterusingAirinspaceplasmairsystemshowedsignificantdifference[(1975.3<356.1)cfu/m3vs.(193.83<29.5)cfu/m3,P<0.01].ConclusionAirinspaceplasmairsystemusedincardiacpostoperativeinfectionwardshasshownremarkableefficacyinreducingairborneparticlesandfungalcontaminationandhelpespreventcrossinfection.

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简介：AbstractBackground:Postoperative pneumonia (POP) is one of the most common infections following heart valve surgery (HVS) and is associated with a significant increase in morbidity, mortality, and health care costs. This study aimed to identify the major risk factors associated with the occurrence of POP following HVS and to derive and validate a clinical risk score.Methods:Adults undergoing open HVS between January 2016 and December 2019 at a single institution were enrolled in this study. Patients were randomly assigned to the derivation and validation sets at 1:1 ratio. A prediction model was developed with multivariable logistic regression analysis in the derivation set. Points were assigned to independent risk factors based on their regression coefficients.Results:POP occurred in 316 of the 3853 patients (8.2%). Multivariable analysis identified ten significant predictors for POP in the derivation set, including older age, smoking history, chronic obstructive pulmonary disease, diabetes mellitus, renal insufficiency, poor cardiac function, heart surgery history, longer cardiopulmonary bypass, blood transfusion, and concomitant coronary and/or aortic surgery. A 22-point risk score based on the multivariable model was then generated, demonstrating good discrimination (C-statistic: 0.81), and calibration (Hosmer-Lemeshow χ2 = 8.234, P = 0.312). The prediction rule also showed adequate discriminative power (C-statistic: 0.83) and calibration (Hosmer-Lemeshow χ2 = 5.606, P = 0.691) in the validation set. Three risk intervals were defined as low-, medium-, and high-risk groups.Conclusion:We derived and validated a 22-point risk score for POP following HVS, which may be useful in preventive interventions and risk management.Trial Registration:Chictr.org, ChiCTR1900028127; http://www.chictr.org.cn/showproj.aspx?proj=46932

简介：Objective:Toinvestigatetheprevalenceoflong-termfatigue,anxiety,depressionandsocialsupport,andtherelationshipsamongthesesymptomsinpostoperativepatientswithbreastcancer.Methods:Atotalof180postoperativepatientswithbreastcancermeetingcriterionwererecruitedinthiscross-sectionalstudy.TheBriefFatigueInventory(BFI),HospitalAnxietyandDepressionScale(HADS)andTheSocialSupportSurvey-Chineseversionwereusedtoassessingthefatigue,anxietyanddepression,Socialsupportofparticipants.ThemagnitudeoftherelationshipamongthesymptomsoffatigueandothervariableswasmeasuredbySpearmanRhocorrelation.Results:Theprevalenceoflong-termfatiguewas52.7%,and18.3%occurredmoderate/severefatigue.Two-thirdsofpatientshadabasalsocialsupport,only12.8%ofpatientshadbetter-perceivedsocialsupport.ResultsofHADSshowedthat16.7%and21.1%oftheparticipantshaveanxietyordepressiondisorder.Moderate/severefatiguewasnegativelycorrelatedwithsocialsupport(r=–0.158,P=0.038)andpositivelycorrelatedwithage(r=0.132,P=0.042),chemotherapy(r=0.297,P=0.027),anxiety(r=0.324,P=0.018)anddepression(r=0.211,P=0.034).Conclusions:Long-termfatiguewashighlyprevalentamongoverhalfofpostoperativepatientswithbreastcancer,andmoderate/severefatiguewasassociatedwithsocialandpsychologicalfactorssuchassocialsupport,anxietyanddepression.Ourresultssuggestthatoverallnursingcaremaybeamoreeffectivemannerinimprovingfatigueandqualityoflife.

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简介：AbstractLung cancer is the leading cause of cancer-related deaths worldwide. Approximately 10%-50% of patients experience relapse after radical surgery, which may be attributed to the persistence of minimal/molecular residual disease (MRD). Circulating tumor DNA (ctDNA), a common liquid biopsy approach, has been demonstrated to have significant clinical merit. In this study, we review the evidence supporting the use of ctDNA for MRD detection and discuss the potential clinical applications of postoperative MRD detection, including monitoring recurrence, guiding adjuvant treatment, and driving clinical trials in lung cancer. We will also discuss the problems that prevent the routine application of ctDNA MRD detection. Multi-analyte methods and identification of specific genetic and molecular alterations, especially methylation, are effective detection strategies and show considerable prospects for future development. Interventional prospective studies based on ctDNA detection are needed to determine whether the application of postoperative MRD detection can improve the clinical outcomes of lung cancer patients, and the accuracy, sensitivity, specificity, and robustness of different detection methods still require optimization and refinement.

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简介：Objective:Curativegastriccancersurgeryentailsremovaloftheprimarytumorwithadequatemarginsincludingregionallymphnodes.Europeanrandomizedcontrolledtrialswithrecruitmentinthe1990'sreportedincreasedmorbidityandmortalityforD2comparedtoD1.Here,weexaminedtheextentoflymphadenectomyduringgastriccancersurgeryandtheassociatedriskforpostoperativecomplicationsandmortalityusingthestrengthsofapopulation-basedstudy.Methods:AprospectivenationwidestudyconductedwithintheNationalRegisterofEsophagealandGastricCancer.AllpatientsinSwedenfrom2006to2013whounderwentgastriccancerresectionswithcurativeintentwereincluded.PatientswerecategorizedintoD0,D1,orD1+/D2,andanalyzedregardingpostoperativemorbidityandmortalityusingmultivariablelogisticregression.Results:Intotal,349(31.7%)patientshadaD0,494(44.9%)D1,and258(23.4%)D1+/D2lymphadenectomy.The30-dpostoperativecomplicationrateswere25.5%,25.1%and32.2%(D0,D1andD1+/D2,respectively),and90-dmortalityrateswere8.3%,4.3%and5.8%.Afteradjustmentforconfounders,inmultivariableanalysis,therewerenosignificantdifferencesinriskforpostoperativecomplicationsbetweenthelymphadenectomygroups.For90-dmortality,therewasalowerriskforD1vs.D0.Conclusions:ThemajorityofgastriccancerresectionsinSwedenhaveincludedonlyalimitedlymphadenectomy(D0andD1).Moreextensivelymphadenectomy(D1+/D2)seemedtohavenoimpactonpostoperativemorbidityormortality.

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简介：AIM:Tostudytheeffectsofglutamine(Gin)onthechangeofintestinalpermeabilityanditsrelationshiptosystemicinflammatoryresponseinearlyabdominalpostoperativepatients.METHODS:Aprospective,randomized,double-blindandcontrolledtrialwastaken.TwentypatientsundergoingabdominalsurgerywererandomizedintoGingroup(oraladministrationofglutamine,30g/d,for7d,n=10)andplacebogroup(oraladministrationofplacebo,30g/d,for7d,n=-10).Temperaturesandheartratesofallpatientsweredailyrecorded.Whitebloodcellcounts(WBC)andbiochemicalvariablesweremeasuredbeforeoperationand4and7dalterdrugadministration.Serumconcentrationsofglutamine,endotoxin,diamineoxidaseandmalondialdehydeandurinelactulose/mannito(L/M)ratioweremeasuredbeforeand7dalterdrugadministration.RESULTS:Thepatientsinthe2groupswerecomparablepriortodrugadministration.SerumGinconcentrationwassignificantlydecreasedintheplacebogroupandincreasedintheGingroup7dalterdrugadministration.UrineL/MratiowassignificantlyincreasedintheplacebogroupanddecreasedintheGingroup.Theserumconcentrationofendotoxin,diamineoxidaseandmalondialdehydewassignificantlydecreasedintheGingroupcomparedwiththoseintheplacebogroup.Temperatures,heartratesandWBCcountsweresignificantlylowerintheGingroupthanthoseintheplacebogroup.CONCLUSION:Gutisoneofthesourcesofsystemicinflammatoryresponseinabdominalpostoperativepatientsandglutaminecandecreaseintestinalpermeability,maintainintestinalbarrierandattenuatesystemicinflammatoryresponseinearlypostoperativepatients.

简介：electrospun(lactide-co-glycolide)(PLGA)poly，膜被准备并且过去常执行跟腱的反粘附。在整个实验，膜显示出适当降级率，并且降级媒介的pH价值在约7.4点被维持。同时，在vitro并且在vivo的膜的优秀biocompatibility被实时/死了、组织病理学说的分析证实。同时，膜能显著地减少腱粘附并且有效地支持功能的恢复。令人鼓舞的结果被hematoxylin和曙红(H&E)进一步表明，并且Massons三色的染色，和类型我骨胶原immunohistochemical分析。没有处理，与electrospunPLGA膜对待的模型比那关于粘附预防和织物修理显著地更好，这被结束。就降级和粘附预防功效的结果而言，electrospunPLGA膜将是手术后的腱粘附的预防的一个大候选人。