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Outcomes Associated with a Screening and Treatment Pathway for Occult Hypoperfusion Following Cardiac Surgery

World Journal of Cardiovascular Surgery 2013年第2期3卷 34-41页

作者： Ran Xu Greg A. Laine BeeBee Y. Hu R. Thomas Solis Arthur W. Bracey Jr. James M. Wilson Amy R. Miclat Susan Baimbridge George J. Reul Jr. Comprehensive Pharmacy Services St Luke’s The Woodlands Hospital The Woodlands USA St Luke’s Episcopal Hospital Houston USA Texas Heart institute Houston USA

Introduction: Routinely monitored parameters such as blood pressure (BP) and heart rate may not reliably detect per- fusion abnormalities. However, central venous oxygen saturation (ScvO2) and lactate levels can detect occult hypoper- fusion (OH) and identify patients at risk for complications. The study objective was to assess the impact of an OH treatment pathway on morbidity and length of stay (LOS) post coronary bypass and valve surgery. Methods: This is a prospective cohort observational study following the implementation of a treatment pathway for OH, defined by ScvO2 2 mMol/L with systolic BP ≥ 90 mmHg. Initial treatment included volume resuscitation and/or blood transfusion, followed by additional interventions when ScvO2 remained hours postoperatively. Primary outcomes were intensive care unit (ICU)/hospital LOS and complications. Results: Comparing 53 patients managed by the OH pathway against 21 historical controls, median ICU LOS was 40.4 vs. 49.2 hours (p = 0.122), median hospital LOS 9.2 vs. 11.0 days (p = 0.0093), ICU readmission rate 7.5% vs. 28.6% (p = 0.026), and complication rate 26.4% vs. 47.6% (p = 0.101). Repeat lactate was checked 18 hours postoperatively in 47 of the 53 patients. Comparing 33 patients with repeat lactate at goal ( 2 mMoL/L) with 14 patients not at goal, median ICU LOS was 35.3 vs. 68.4 hours (p = 0.061), median hospital LOS 8.9 vs. 11.2 days (p = 0.058), median length of mechanical ventilation (LOMV) 13.3 vs. 28.4 hours (p = 0.0038), and complication rate 15.2% vs. 50.0% (p = 0.025). Conclusions: An OH screening and treatment pathway following cardiovascular surgery was associated with signifi- cantly shorter hospital LOS and lower ICU readmission rate. Among the OH pathway patients, achieving lactate goal 18 hours postoperatively was associated with significantly shorter LOMV and lower complication rate.

关键词： Occult Hypoperfusion Cardiovascular Surgery Lactate Central Venous Oxygen Saturation Outcomes

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Erythropoiesis-stimulating agents in the management of cancer patients with anemia: a meta-analysis

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Chinese Journal of Cancer Research 2014年第3期26卷 268-276页

作者： Xiaomei Li Zhi Yan Dexiao Kong Wen Zou Jihua Wang Dianshui Sun Yuhua Jiang Chengyun Zheng Cancer Center of the Second Hospital Shandong University institute of Biotherapy for Hematological Malignancies Shandong University Cardiovascular Department of the Second Hospital Shandong University Hematology Department of the Second Hospital Shandong University Pharmacology Department of the Second Hospital Shandong University

Background： Erythropoiesis-stimulating agents （ESAs） are widely used in the management of anemia in cancer patients. Despite their apparent effectiveness, recent studies have suggested that ESAs could result in serious adverse events and even higher mortality. The aim of the current study was to evaluate the benefits and risks of ESAs in the management of cancer patients with anemia using a recta-analysis. Methods： The initial literature search covered Medline, PubMed, Embase, and the Cochrane Center Register of Controlled Trials, and identified 1,569 articles. The final meta-analysis included eight randomized controlled trials （n=2,387） in cancer patients with 〈11 g/dL hemoglobin （Hb） at the baseline and target Hb （for stopping ESA treatment） at no more than 13 g/dL. The assessment measures included Hb response, blood transfusion rate and adverse events that included venous thromboemblism （VTE）, hypertension, and on-study mortality. The results are expressed as pooled odds ratio （OR）. Publication bias was assessed using funnel plot analysis. Results： ESAs significantly increased the Hb concentration [OR 7.85, 95% confidence interval （CI）： 5.85 to 10.53, P〈O.O01] and reduced the red blood cell （RBC） transfusion rate （OR 0.52, 95% CI： 0.42 to 0.65, P〈0.001）. ESAs did not increase the accumulated adverse events （OR 0.95, P=0.82）, or the on-study mortality （OR 1.09, P=0.47）. Conclusions： ESAs are not associated with increased frequency of severe adverse events in anemic cancer patients when the target Hb value is no more than 13 g/dL.

关键词： Adverse events anemia cancer erythropoiesis-stimulafing agents (ESAs)

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Primary biliary cirrhosis-associated hepatocellular carcinoma in Chinese patients:Incidence and risk factors

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World Journal of Gastroenterology 2015年第12期21卷 3554-3563页

作者： Xue-Xiu Zhang Li-Feng Wang Lei Jin Yuan-Yuan Li Shu-Li Hao Yan-Chao Shi Qing-Lei Zeng Zhi-Wei Li Zheng Zhang George KK Lau Fu-Sheng Wang The institute of Translational Hepatology 302 Military Hospital of China-Peking University Teaching Hospital Research Center for Biological Therapy Beijing 302 Hospital Non-Infectious Liver Disease Diagnosis and Treatment Center 302 Military Hospital of China-Peking University Teaching Hospital Research Center for Liver Transplantation 302 Military Hospital of China-Peking University Teaching Hospital Department for Hepatobiliary Surgery Beijing 302 Hospital

AIM: To investigate the incidence, characteristics, and risk factors for hepatocellular carcinoma(HCC) in Chinese patients with primary biliary cirrhosis(PBC).METHODS: We reviewed the data of 52 PB Cassociated HCC patients treated at Beijing 302 Hospital from January 2002 to December 2013 and analyzed its incidence and characteristics between the two genders. The risk factors for PBC-associated HCC were analyzed via a case-control study comprising 20 PBC patients with HCC and 77 matched controls without HCC. The matched factors included gender, age, follow-up period and Child-Pugh scores. Conditional logistic regression was used to evaluate the odds ratios of potential risk factors for HCC development. A P transfusion(18.75% vs 8.33%, P = 0.043), consumed alcohol(31.25% vs 8.33%, P = 0.010), smoked(31.25% vs 8.33%, P = 0.010), had a family history of malignancy(25% vs 5.56%, P = 0.012), and had serious liver inflammation, as indicated by the elevated levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and γ-glutamyl transpeptidase(P < 0.05). Conditional logistic regression analysis revealed that body mass index(BMI) ≥ 25 [adjusted odds ratio(AOR) = 1.116, 95%CI: 1.002-1.244, P = 0.045] and history of alcohol intake(AOR = 10.294, 95%CI: 1.108-95.680, P = 0.040) were significantly associated with increased odds of HCC development in PBC patients. CONCLUSION: HCC is not rare in Chinese PBC patients. Risk factors for PBC-associated HCC include BMI ≥ 25 and a history of alcohol intake. In addition to regul

关键词： Primary biliary cirrhosis Hepatocellular carcinoma

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Robot-assisted adrenalectomy:Step-by-step technique and surgical outcomes at a high-volume robotic center

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Asian Journal of Urology 2023年第4期10卷 475-481页

作者： Federico Piramide Carlo Andrea Bravi Marco Paciotti Luca Sarchi Luigi Nocera Adele Piro Maria Peraire Lores Eleonora Balestrazzi Angelo Mottaran Rui Farinha Hubert Nicolas Pieter De Backer Frederiek D'hondt Peter Schatteman Ruben De Groote Geert De Naeyer Alexandre Mottrie Department of Urology Onze-Lieve-VrouwziekenhuisAalstBelgium ORSI Academy GhentBelgium Department of Oncology Division of UrologyUniversity of TurinSan Luigi Gonzaga HospitalTurinItaly Department of Urology Humanitas Research Hospital-IRCCSRozzanoItaly Department of Urology ASST Santi Paolo e CarloUniversity of MilanMilanItaly Unit of Urology Division of Experimental OncologyUrological Research InstituteIRCCS San Raffaele Scientific InstituteVita-Salute San Raffaele UniversityMilanItaly Department of Urology Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense ModenaUniversity of Modena and Reggio EmiliaModenaItaly Division of Urology IRCCS Azienda Ospedaliero-Universitaria di BolognaBolognaItaly Urological Department La CitadelleLiègeBelgium

Objective In the last years,robotic surgery was introduced in several different settings with good perioperative ***,its role in the management of adrenal masses is still *** order to provide a contribution to this field,we described our step-by-step technique for robotic adrenalectomy(RA)and related modifications according to the type of adrenal mass *** We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital(Aalst,Belgium)between January 2009 and October ***,intra-and post-operative,and pathological data were retrieved from our prospectively maintained institutional *** variables are summarized as median and interquartile range(IQR).Categorical variables are reported as frequencies(percentages).Results Twenty-seven patients underwent RA were included in the *** age,body mass index,and Charlson's comorbidity index were 61(IQR:49-71)years,26(IQR:24-29)kg/m^(2),and 2(IQR:0-3),respectively,and 16(59.3%)patients were *** tumor size at computed tomography scan was 6.0(IQR:3.5-8.0)*** operative time and blood loss were 105(IQR:82-120)min and 175(IQR:94-250)mL,*** intraoperative complications were *** postoperative complications rate was 11.1%,with a postoperative transfusion rate of 3.7%.A total of 10(37.0%)patients harbored malignant adrenal *** them,3(11.1%)had adrenocortical carcinoma,6(22.2%)secondary metastasis,and 1(3.7%)malignant pheochromocytoma on final pathological *** 1(10.0%)patient had positive surgical *** We described our step-by-step technique for RA,which can be safely performed even in case of high challenging settings as malignant tumors,pheochromocytoma,and large *** standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.

关键词： Robotics Adrenalectomy Pheochromocytoma Malignant Surgical technique

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Hemocoagulase Injection blood anesthesia in joint operation

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Journal of Medical Colleges of PLA(China) 2011年第3期26卷 152-157页

作者： Li Yang Department of Anesthesia Affiliated Hospital of Hubei Institute for Nationalities Enshi 445000 China

Objective:To investigate the role of Hemocoagulase Injection used in the joint operation and the effect on the blood coagulable ***:A total of 60 patients who undergoing joint operation in our hospital were randomly divided into two *** group(Group A,n=30)was injected with 2 U Hemocoagulase Injection in 5 min before anesthesia *** contrast group(Group B,n=30)was treated with 0.9%normal saline in 5 min before anesthesia *** common anesthesia was given to the two groups of *** venous blood was withdrawn for blood routine examination,thrombelastography and coagulable function at the time of pre-inducement, end of operation,and in 6 and 12 h after *** change of thrombelastograph and coagulable state were monitored during the whole *** the volume of transfusion and hemorrhage between two groups was contrasted. Results:After the use of Hemocoagulase Injection,the operative time was shortened obviously(Ptransfusion was obviously smaller in Group A than in Group B(P0.05).Conclusion:Hemocoagulase Injection can reduce the volumes of hemorrhage and transfusion and not influence the coagulable *** is worth using in the joint operation.

关键词： Hemocoagulase Injection Anesthesia Joint operation

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Relationship between surgical time and postoperative complications in senile patients with hip fractures

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Chinese Journal of Traumatology 2010年第3期13卷 167-172页

作者：马韧石谷贵山王成学朱东张西正 Department of Bone and Joint Surgery First Hospital of Jilin University Changchun 130021 China institute of Medical Equipment Military Medical Science Academy of PLA Tianjin 300161 China

Objective：To elucidate the relationship between surgical time and postoperative complications in senile patients with hip fractures, and try to find out other factors which are related to these ***： Sixty-two patients, 28 males aged from 65 to 72 years with a mean age of 76.3 years and 34 females aged from 65 to 95 years with a mean age of 78.1 years, who had undergone orthopedic surgery because of hip fractures,were enrolled in a retrospective cohort study. The surgical time and pattern, the type of fracture, preoperative comorbidities, American Society of Anesthesiologists （ASA） score and the volume of blood transfusion during operation were obtained from these patients who were followed up by telephone calls for postoperative *** the patients were followed up at least for 1 year and were divided into subgroups according to their clinical characteristics and the results were analyzed by the Statistical Analysis System ***：There was no significant difference in the morbidity of postoperative eomplications with the gender,age,surgical time and pattern,or ASA score. There was significant difference in the morbidity of postoperative complications related to preoperative comorbidities and the volume of blood transfusion. There was a significant causality between preoperative comorbidities and postoperative complications. The morbidity of postoperative complications was 1.651 times higher in patients with preoperative comorbidities than those ***：There is no relationship between the surgical time and postoperative complications in senile patients who received surgery for hip fracture within 1 *** correlation is found between the postoperative complications and gender,age,type of fracture, surgical pattern,ASA score and the volume of blood transfusion. Preoperative comorbidities are an independent predictor for postoperative complications.

关键词： Hip fractures Osteoporosis Postoperative complications

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Perioperative blood transfusion does not adversely affect survival in gastric cancer patients after surgery:a propensity score analysis

Perioperative blood transfusion does not adversely affect su...

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第八届中国肿瘤学术大会暨第十三届海峡两岸肿瘤学术会议

作者： Jingli Cui Han Liang Jingyu Deng Xuewei Ding Xiaona Wang Li Zhang Department of gastric cancer Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center of Cancer Key Laboratory of Cancer Prevention and Therapy

＜正＞Backgroud The impact of perioperative blood transfusion（PBT）on the prognosis of gastric cancer remains *** sought to evaluate the association of PBT with mortality of gastric cancer after surgery by applying p...

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Knowledge Attitudes, Practices and Factors Associated with Blood Donation in the Fatick Health District in 2019 (Senegal)

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Open Journal of Preventive medicine 2021年第4期11卷 132-146页

作者： Fatoumata Binetou Diongue Oumar Bassoum Jean Augustin Diégane Tine Abiboulaye Sall Khadim Niang Mamadou Matar Mbacké Leye Amadou Ibra Diallo Adama Faye institute of Health and Development Cheikh Anta Diop University of Dakar Dakar Senegal Health District of Fatick Fatick Senegal Training and Research Unit in Health Sciences of Sant-Louis Saint-Louis Senegal

Introduction: Timely availability of safe blood or blood products is essential for all health care facilities where transfusion occurs, but in many developing and transitional countries, there is still a considerable gap between the need for blood and the supply available. The overall objective was to study knowledge attitudes, practices, and factors influencing blood donation in the general population in Senegal. Methods: This was a cross-sectional descriptive and analytical study conducted among the Fatick health district population from April 1 to 15, 2019. Thus, the sample is based on a two-stage survey. Data collection was conducted through a questionnaire designed, pretested, and administered to 466 people by selected and trained enumerators. The data collected on the smartphone was analyzed using Epi Info 7.***.1.0 software. A descriptive and bivariate analysis was performed with a 5% risk of alpha error. Results: The average age of respondents was 35 years (±13), with 34 years (±12) for women and 38 years (±15) for men, and more than half of them between 20 and 40 years of age. A proportion of 87% of respondents lived in rural areas and had agriculture as their primary income source. More than half of the individuals (70%) were married, and 68% were educated. The level of knowledge of individuals about blood donation was low at 91.8%. On the other hand, more than half of them had good habits (53.65%). A proportion of 68.0% of individuals had an intention to donate in the future. However, only 24.68% of the population surveyed had already donated blood. Eighty percent of the donations were voluntary. However, 26.09% had repeated this practice. Factors that could influence the practice of blood donation were age, male sex (ORb = 2.18 [1.40 - 3. 37]), high level of education, good knowledge of blood donation (ORb = 2.14 [1.07 - 4.26]), the existence of a relatives donor (ORb = 3.4 [2.19 - 5.26]) and individuals w

关键词： Knowledge Attitudes and Practices Associated Factors Blood Donation Fatick District Senegal

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HLA-A,B,DRB1单体型频率计算及其在骨髓库中的应用

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中国输血杂志 2005年第4期18卷 280-285页

作者：孙继丽杜可明傅敏季芸谢军华孙瑛金晔杨剑豪稽月华刘达庄钱开诚赵桐茂上海市血液中心上海200035 National institute of Health

目的从群体资料计算HLAA,B,DRB1三座位单体型频率,并用于骨髓库寻找HLA匹配供者。方法根据HLA表型群体资料,使用最大数学预期值算法(ExpectationMaximization,EM)计算HLA三座位单体型频率。通过实例运算介绍HLA表型频率以及发现HLA匹配... 详细信息

目的从群体资料计算HLAA,B,DRB1三座位单体型频率,并用于骨髓库寻找HLA匹配供者。方法根据HLA表型群体资料,使用最大数学预期值算法(ExpectationMaximization,EM)计算HLA三座位单体型频率。通过实例运算介绍HLA表型频率以及发现HLA匹配无关供者的概率。结果①使用DNA基因分型技术鉴定12193例无关汉族健康个体HLA表型,计算求得HLAA,B,DRB1单体型频率。②预期概率与观察结果吻合,并用于评估骨髓库的最适大小。结论使用EM算法估计大样本汉族群体HLAA,B,DRB1三座位单体型频率,结果可靠,可用于评估骨髓库的最适大小和组份。

关键词： HLA—A,B,DRB1单体型频率 EM算法发现HLA匹配供者概率

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关于心脏手术中自体血回收有效性随机试验的荟萃分析

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麻醉与镇痛 2011年第3期7卷 1-13页

作者： Guyan Wang,MD, PhD Daniel Bainbridge, MD, FRCPC Janet Martin, PharmD, mSc(HTA&M) Davy Cheng, MD, MSc, FRCPC, FCAHS 蒋琦亮(译) Department of Anesthesia and Perioperative medicine London Health Sciences Centre University of Western Ontario London Ontario Canada Department of Anesthesiology Cardiovascular Institute and Fuwai Hospital Peking Union Medical College Chinese Academy of Medical Sdences Beiiing China Department of Anesthesiology and Perioperative medicine Evidence-Based Perioperative Clinical Outcomes Research Group (EPiCOR) London Health Sciences Centre University of Western Ontario London Ontario Canada Department of Pharmacy Physiology and Pharmacology High Impact Technology Evaluation Centre Pharmacy Physiology and Pharmacology London Health Sciences Centre University of Western Ontario London Ontario Canada 不详

背景在心脏手术中可以通过自体血回收来避免输注同种异体血。另外已有人提出，血液中的碎片可能会增加卒中或神经意识功能障碍的风险，因此，清除回收血中的碎片可改善患者的预后。在此研究中，我们试图通过系统性回顾已发表的随机控制... 详细信息

背景在心脏手术中可以通过自体血回收来避免输注同种异体血。另外已有人提出，血液中的碎片可能会增加卒中或神经意识功能障碍的风险，因此，清除回收血中的碎片可改善患者的预后。在此研究中，我们试图通过系统性回顾已发表的随机控制性试验进行荟萃分析，明确在心脏手术中自体血回收的整体安全性和有效性。方法全面检索找出关于所有有关心脏手术中应用自体血回收技术的所有随机试验。截止到2008年11月的MEDLINE、Cochrane图书馆、EMBASE和摘要资料库均被检索完全。将所有心脏手术中应用自体血回收技术与未应用自体血回收技术进行比较，并且报道至少一个明确的临床结果的随机试验均被列为研究对象。随机效应模型被用来依次计算比值比（OR，95％可信区间）、二分法加权平均差（WMD，95％可信区间）和连续变量。结果包括2282例患者在内的31个随机试验最终被作为研究对象进行荟萃分析。在心脏手术中，进行手术中自体血回收减少了接触同种异体异基因血制品（比值比0．63，95％可信区间：0．43—0．94，P=0．02）及红细胞（比值比0．60，95％可信区间：0．39—0．92，P=0．02）的概率，也降低了平均每例患者输注同种异体异基因血制品的总量（加权平均差-256ml，95％可信区间：-416--95ml，P=0．002）。但在以下几个方面进行自体血回收组与未进行自体血回收组之间并无差异，包括：院内死亡率（比值比0．65，95％可信区间：0．25—1．68，P=0．37）、手术后卒中或短暂缺血性发作（比值比0．59，95％可信区间：0．20～1．76，P=0．34）、房颤（比值比0．92，95％可信区间：0．69—1．23，P=0．56）、肾功能衰竭（比值比0．86，95％可信区间：0．41—1．80，P=0．70）、感染（比值比1．25，95％可信区间：0．75—2．10，P=0．39）、接受新鲜冰冻血浆治疗（比值比1．16，95％可信区间：0．82—1．66，P=0．40）以及接受血小板输注治疗（比值比0．90，95％可信区间：0．63—1．28，P=0．55）。结论现有的证据表明应用自体血回收技术可减少心脏手术中患者异体血制品或红细胞的输注。进一步的分析认为，只有在收集失血和（或）剩余机血，或在整个手术过程中应用自体血回收技术才是有利的。如果只在体外循环期间用自体血回收技术作为心内吸引，则对于血液保护没有明显效应且增加新鲜冰冻血浆的输注。

关键词：自体血回收技术随机试验荟萃分析手术中有效性心脏 Cochrane图书馆新鲜冰冻血浆

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