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Effect of methylprednisolone therapy on Hospital stay and viral clearance in patients with moderate COVID-19

Infectious Medicine 2022年第4期1卷 236-244页

作者： Xiaoyan Li Xin Yuan Zhe Xu Lei Huang Lei Shi Xuechun Lu Fu-Sheng Wang Junliang Fu Medical School of Chinese PLA BeijingChina Senior Department of Infectious Diseases The Fifth Medical Center of Chinese PLA General HospitalBeijingChina National Clinical Research Center for Infectious Diseases BeijingChina Department of Hematology the Second Medical Center of Chinese PLA General HospitalBeijingChina

Background:The benefits and harms of methylprednisolone treatment in patients with moderate coronavirus disease 2019(COVID-19)remain controversial.In this study,we investigated the effect of methylprednisolone on mortality rate,viral clearance,and hospitalization stay in patients with moderate COVID-19.Methods:This retrospective study included 4827 patients admitted to Wuhan Huoshenshan and Wuhan Guanggu hospitals from February to March 2020 diagnosed with COVID-19 pneumonia.The participants’epidemiological and demographic data,comorbidities,laboratory test results,treatments,outcomes,and vital clinical time points were extracted from electronic medical records.The primary outcome was in-hospital death;secondary outcomes were time from admission to viral clearance and Hospital stay.Univariate and multivariate logistic or linear regression analysis were used to assess the roles of methylprednisolone in different outcomes.The propensity score matching(PSM)method was used to control for confounding factors.Results:A total of 1320 patients were included in this study,of whom 100 received methylprednisolone.Overall,in-hospital mortality was 0.91%(12/1320);the 12 patients who died were all in the methylprednisolone group,though multivariate logistic regression analysis showed methylprednisolone treatment was not a risk factor for in-hospital death in moderate patients before or after adjustment for confounders by PSM.Methylprednisolone treatment was correlated with longer length from admission to viral clearance time and Hospital stay before and after adjustment for confounders.Conclusions:Methylprednisolone therapy was not associated with increased in-hospital mortality but with delayed viral clearance and extended Hospital stay in moderate COVID-19 patients.

关键词： COVID-19 Hospital stay In-hospital death Moderate Viral clearance

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Effect of body mass index on the operation time and postoperative Hospital stay of retroperitoneal laparoscopic renal cyst decortication

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Laparoscopic, Endoscopic and Robotic Surgery 2021年第2期4卷 40-43页

作者： Peng Gu Meilin Li Minhao Zhang Xiaoliang He Department of Urology Wuxi Xishan People's HospitalWuxi 214105China Department of General Medicine Wuxi No.5 People's HospitalWuxi 214001China

Objective:To investigate the effect of body mass index(BMI)on the operation time and postoperative Hospital stay for patients who underwent retroperitoneal laparoscopic decortication for a single simple renal cyst.Methods:A retrospective cohort study was conducted among 81 patients with single simple renal cyst who had undergone retroperitoneal laparoscopic cyst decortication from January 2017 to December 2019 in Wuxi Xishan People's hospital.All patients were divided into three groups according to BMI:normal group(BMI30 kg/m^(2),n=16).Multiple linear regression was conducted to investigate the correlation.Results:The three groups were comparable in terms of age,gender,maximum diameter of cyst,and cyst location.In the aspect of operation time,only the patients in obese group had longer duration when compared with those in the normal group(59.1±15.7 min vs.45.2±12.8 min,p=0.001).And the patients in the obese group had significantly longer Hospital stay compared with those in the normal group(6.2±1.9 d vs.5.2±0.5 d,p=0.002)and overweight group(6.2±1.9 d vs.5.0±1.0d,p=0.001).In the analysis of multiple linear regression,it was found that operation time is significantly affected by BMI and location 2,with coefficients of 1.299 and -8.646 respectively.The influence of BMI was greater than location 2(0.335 vs.-0.289).For Hospital stay,only BMI had an effect on it,with a coefficient of 0.110.Conclusion:BMI was a major factor that associated with longer operation time and Hospital stay in patients with retroperitoneal laparoscopic renal cyst decortication.

关键词： Body mass index Renal cyst Laparoscopic decortication Operation time Hospital stay

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Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure

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World Journal of Gastroenterology 2023年第29期29卷 4571-4579页

作者： Chang Chen Xiang Zhang Zhi-Qiang Cheng Bin-Bin Zhang Xin Li Ke-Xin Wang Yong Dai Yan-Lei Wang Department of Colorectal Surgery Qilu HospitalShandong UniversityJinan 250012Shandong ProvinceChina Department of Nursing Qilu Hospital of Shandong University De Zhou HospitalDezhou 254300Shandong ProvinceChin Department of General Surgery Huantai Branch of Qilu Hospital of Shandong UniversityZibo 255000Shandong ProvinceChina

BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of Hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient i

关键词： Enterostomy Abdominal wound closure technique Suture techniques Surgical wound infection hospital costs Hospital stay

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Patient Experience during Hospital stay: A Pilot Survey

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Health 2016年第14期8卷 1518-1528页

作者： Satyanarayana V. Sagi Cong Chen Kyaw Z. Htun Kalyani Puvanendrampillai Medhavi Ratnayake Joseph Ngwira Jeyanthy Rajkanna Samson O. Oyibo Department of General Medicine Peterborough City Hospital Peterborough UK

Introduction: hospital inpatient care is provided to individuals who have a condition that requires them to stay in hospital. Patient experience is an important aspect of high-quality patient-centered care. Aim: With this pilot survey we aimed to obtain patient feedback on their experiences during their Hospital stay, highlight areas of best practice and areas for improvement and provide a basis for a hospital-wide inpatient experience survey. Patients and Methods: Anonymous patient experience questionnaires were given to patients who were discharged from hospital during the month of May 2016. Patients were asked to answer 45 questions concerning their experience during Hospital stay using the five-point Likert scale, and hand back the questionnaire before leaving the hospital. A suggestion box was provided for comments and suggestions for improvement. Results: Fifty-six questionnaires were handed out and 50 (from 27 males, 17 females and 6 patients who did not specify their gender) questionnaires were returned (89% response rate). Most of the responses fell within the “agree” to “strongly agree” range indicating a positive patient experience for most of the items addressed. Patients also provided useful comments and suggestions. Conclusion: Results of this survey indicate that patients generally had a positive experience during their Hospital stay. This survey has revealed areas for improvement, and highlights the importance of patient experience when assessing a patient-centered service.

关键词： Patient Experience Inpatients Hospital stay Patient-Centered Care

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Effects of multimodal fast-track surgery on liver transplantation outcomes

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Hepatobiliary & Pancreatic Diseases International 2017年第4期16卷 364-369页

作者： Jian-Hua Rao Feng Zhang Hao Lu Xin-Zheng Dai Chuan-Yong Zhang Xiao-Feng Qian Xue-Hao Wang Ling Lu Liver Transplantation Center First Affiliated Hospital of Nanjing Medical University Key Laboratory of Living Donor Liver Transplantation of Ministry of Public Health Nanjing 210029China

BACKGROUND: Fast-track surgery and enhanced recovery after surgery have been applied to many surgical procedures; however, data on fast-track surgery and enhanced recovery after surgery following liver transplantation is limited. This study aimed to conduct a prospective study to determine the effects of fast-track surgery on prognosis after liver transplantation. METHODS: This was a prospective, single-blinded, randomized study. One hundred twenty-eight patients undergoing liver transplantation were selected for the fast-track (FT group, n=54) or conventional process (NFT group, n=74). The primary endpoints were intensive care unit (ICU) stay and Hospital stay. The secondary endpoints were as follows: operative time, anhepatic phase time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative complications, readmission rate, and postoperative mortality. RESULTS: There was no significant difference in preoperative demographics between the two groups. The median ICU stay was 2 days (range 1-7 days) in the FT group and 5 days (range 3-12 days) in the NFT group (PHospital stay was also significantly reduced in the FT group (Pstay and Hospital stay may be positively correlated with operative time, anhepatic phase time and intraoperative blood loss. There were no differences in the incidence of postoperative complications, readmissions, and postoperative mortality between the two groups. CONCLUSION: Fast-track procedures effectively reduce the ICU stay and Hospital stay without adversely affecting prognosis. This study demonstrated that fast-track protocols are safe and feasible in liver transplantation.

关键词： fast-track surgery liver transplantation surgical drainage ICU days Hospital stay

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Robotic assisted laparoscopic simple suprapubic prostatectomy--The Smith Institute for Urology experience with an evolving technique

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Asian Journal of Urology 2014年第1期1卷 55-59页

作者： Sammy E.Elsamra Nikhil Gupta Haris Ahmed David Leavitt Jessica Kreshover Louis Kavoussi Lee Richstone The Smith Institute for Urology New Hyde ParkNYUSA

Objective:Despite a multitude of minimally invasive surgical options available for benign prostatic enlargement,open simple prostatectomy(OSP)remains the standard for large prostates(typically greater than 100 g).OSP,however,is associated with significant morbidity.Recently,a few reports touting robotic application to simple prostatectomy have been published.Herein,we reviewed our series of robotic assisted laparoscopic simple suprapubic prostatectomy(RALSSP)and detailed modifications in our technique as our experience increased.Methods:All RALSSP cases performed between January 2013 and January 2014 were reviewed for demographics,pre-operative features,and perioperative outcomes.All parameters were tabulated and mean values were calculated.Student’s t-test was utilized with pHospital stay(LOS)was 2.4 days and only five patients required continuous bladder irrigation(CBI)postoperatively.Postoperative PVR improved to a mean of 33 mL and IPSS improved to 4.5(p<0.001).No major complications were identified.Adaptation of low transverse cystotomy,utilization of a robotic tenaculum in the#3 arm with its control by a surgeon on a second console,and the utilization of mucosal advancement have all subjectively aided in performance of RALSSP and perioperative

关键词： Robotic assisted laparoscopic simple suprapubic prostatectomy Benign prostatic hyperplasia Blood loss Hospital stay

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Clinical Significance of Liver Function Abnormality in Patients with COVID-19:A Single-center Experience from Western India

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Journal of Clinical and Translational Hepatology 2021年第6期9卷 878-888页

作者： Chetan R.Kalal Harshad Joshi Vivek Kumar Divya Gopal Darshana Rathod Ashish Shukla Tarang Gianchandani Chetan Bhatt Department of Gastroenterology Hepatology and Liver TransplantSir HN Reliance Foundation Hospital and Research Cen-treMumbaiMaharashtraIndia Department of Critical Care Sir HN Reliance Foundation Hospital and Research CentreMumbaiMaharashtraIndia Department of Administration Sir HN Reliance Foundation Hospital and Research CentreMumbaiMaharashtraIndia

Background and Aims:The impact of coronavirus disease-2019(COVID-19)on liver function remains to be fully elucidated.This study was designed to investigate such and determine the clinical significance in determining mortality risk.Methods:A retrospective study was conducted in patients with COVID-19 from March 2020 to July 2020.Clinical details were retrieved from electronic medical records to obtain clinical characteristics,medical history,laboratory tests,therapeutic intervention,and outcome data.Results:A total of 184 patients with COVID-19 were included(median age:45.5 years),comprised of 62.5%men.In total,22(12.0%)patients had severe infection and 162(88.0%)had mild to moderate infection.Overall,95(51.6%)showed abnormal liver function test(LFT)and 17(9.2%)showed normal LFT at admission.The median age,Hospital stay,and LFT were significantly higher in severe vs.non-severe infection(pHospital stay and number of intensive care unit admissions were higher in patients having abnormal LFT compared to normal LFT.Incidence of elevated aspartate aminotransferase(42.8%and 40.4%),alanine transaminase(43.7%and 41.6%),and hypoalbuminemia(71.4%and72.7%)at admission and discharge were more common in severe infection.The mean survival was significantly lower in severe infection compared to those with non-severe disease(17.2 vs.52.3 days;pHospital stay;mortality was associated with severity of COVID-19.For ruling out the risk of liver injury,it is crucial to vigilantly monitor the liver function parameters in patients with COVID-19 admitted to hospital.

关键词： ALT/AST Hospital stay Hypoalbuminemia Liver injury Severe disease

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Robotic vs laparoscopic right colectomy—the burden of age and comorbidity in perioperative outcomes: An observational study

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World Journal of Gastrointestinal Surgery 2020年第6期12卷 287-297页

作者： Fulvio Tagliabue Morena Burati Marco Chiarelli Luca Fumagalli Angelo Guttadauro Elisa Arborio Matilde De Simone Ugo Cioffi Department of Robotic and Emergency Surgery Ospedale A.ManzoniASST LeccoLecco 23900Italy Department of Surgery University of Milan-BicoccaIstituti Clinici ZucchiMonza 20900Italy Department of Surgery University of MilanMilano 20122Italy

BACKGROUND Several studies have shown the safety,feasibility and oncologic adequacy of robotic right hemicolectomy(RRH).Laparoscopic right hemicolectomy(LRH)is considered technically challenging.Robotic surgery has been introduced to overcome this technical limitation,but it is related to high costs.To maximize the benefits of such surgery,only selected patients are candidates for this technique.In addition,due to progressive aging of the population,an increasing number of minimally invasive procedures are performed on elderly patients with severe comorbidities,who are usually more prone to post-operative complications.AIM To investigate the outcomes of RRH vs LRH with regard to age and comorbidities.METHODS We retrospectively analyzed 123 minimally invasive procedures(68 LRHs vs 55 RRHs)for right colon cancer or endoscopically unresectable adenoma performed in our Center from January 2014 until September 2019.The surgical procedures were performed according to standardized techniques.The primary clinical outcome of the study was the length of Hospital stay(LOS)measured in days.Secondary outcomes were time to first flatus(TFF)and time to first stool evacuation.The robotic technique was considered the exposure and the laparoscopic technique was considered the control.Routine demographic variables were obtained,including age at time of surgery and gender.Body mass index and American Society of Anesthesiologists physical status were registered.The age-adjusted Charlson Comorbidity Index(ACCI)was calculated;the tumornode-metastasis system,intra-operative variables and post-operative complications were recorded.Post-operative follow-up was 180 d.RESULTS LOS,TFF,and time to first stool were significantly shorter in the robotic group:Median 6[interquartile range(IQR)5-8]vs 7(IQR 6-10.5)d,P=0.028;median 2(IQR 1-3)vs 3(IQR 2-4)d,Phospitalization and fa

关键词： Right hemicolectomy Robotic surgery Laparoscopic surgery Elderly patients Comorbidity Hospital stay

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Economic burden of inpatients with viral hepatitis B-related diseases and the influencing factors

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Family Medicine and Community Health 2013年第4期1卷 31-35页

作者： Hua Zhang Jianqian Chao Liguo Zhu Long Song Xiyan Li Pei Liu School of Public Health of Southeast University NanjingJiangsu 210009China Jiangsu Provincial Center for Disease Control and Prevention NanjingJiangsu 210009China

Objective:The purpose of this study was to analyze the economic burden of inpatients with hepatitis B virus(HBV)-related diseases and the influencing factors so as to provide an effective basis for the development of health prevention and control strategies.Methods:The patients were selected by means of successive sampling in the period between August and December 2012 from those who were diagnosed with HBV-related diseases and hospitalized in countylevel medical institutions of Jiangsu Province.One hundred ninety-six patients were studied,including 3 patients with acute HBV,141 with chronic HBV,18 with compensatory cirrhosis,22 with decompensated cirrhosis,and 12 with liver cancer.This study adopted a questionnaire method to investigate and calculate the direct and indirect economic burden of the subjects according to disease economic burden theories and methods.Multiple linear stepwise regression was used for analysis of the influencing factors for economic burden of inpatients with HBV-related diseases.Results:The average economic burden for the 196 inpatients investigated was RMB 28,971.The direct economic burden was RMB 19,916(68.7%),including direct medical costs(RMB 19,087;95.8%)and direct non-medical costs(RMB 829;4.2%).The indirect economic burden was RMB 9055(31.3%),including patient-related expenses(RMB 6348;70.1%)and nursing expenses(RMB 2707;29.9%).According to the multiple linear stepwise regression analysis results,the Hospital stay,proportion of medicine,age,and disease type affected the economic burden of the patients(Phospitalization,especially the direct economic burden.Therefore,the inpatients’economic burden can be reduced by shortening the Hospital stay,reducing the medical expenses reasonably,and delaying the progression of disease as far as possible according to medical standards.

关键词： Hepatitis B Economic burden Influencing factor Hospital stay Medical expenses Progression of disease

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Care Measures and Health Outcomes in a Pediatric Intensive Care Unit in Brazil

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Open Journal of Pediatrics 2023年第5期13卷 697-706页

作者： Arnildo Linck Junior Flávia Lopes Gabani Edmarlon Girotto Ana Maria Rigo Silva Selma Maffei Andrade Department of Pediatrics and Pediatric Surgery Universidade Estadual de Londrina Londrina Brazil

Introduction: In low- and middle-income countries, including Brazil, conditions that favor mortality in the PICU remain significant. Compared to developed countries, there is a shortage of skilled human resources, lower availability of technological resources, greater difficulty of access and a higher incidence of infections, including both those acquired prior to admission and those resulting from treatment and hospitalization (i.e., healthcare-associated infections (HAIs)). HAIs in the PICU include ventilator-associated pneumonia and catheter-related bloodstream infections. Actions for the prevention of HAIs can minimize the occurrence of negative outcomes. Materials and Methods: This is an epidemiological study comparing admissions at the PICU of a high-complexity hospital in South Brazil over two three-year periods: 2012-2014 (before the measures were adopted) and 2015-2017 (after the measures). The care measures were adopted mainly at the beginning of 2015 and consisted of expansion of physical therapy care, adoption of care protocols, acquisition of new materials and equipment (transparent dressings for central catheters, high-tech mechanical ventilators and multiparametric monitors) and multidisciplinary team training. The frequency of the outcomes mortality, length of PICU stay, diagnosis of catheter-related bloodstream infection, need for and duration of ventilatory support and diagnosis of ventilator-associated pneumonia were compared between the two trienniums using logistic regression with adjustment for age in months and need of vasoactive drugs. Results: A total of 1140 admissions were analyzed (470 in the first triennium and 670 in the second), representing an increase in the admission rate of 42.6% after the adoption of the measures. After adjustments, significant reductions in the frequency of mortality (adjusted OR [adjOR] = 0.54;CI 95%: 0.34 - 0.84), length of PICU stay > 7 days (adjOR = 0.75;CI 95%: 0.57 - 0.97) and duration of ventilatory support > 7 days (adjOR = 0.54;CI 95%: 0.39 - 0.74) we

关键词： Pediatric Intensive Care Units Outcomes Assessment In-hospital Mortality Hospital stay Mechanical Ventilation Catheter-Related Infections

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