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: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：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：Coronaryarterybypassgrafting(CABG)isenteringaneweraasminimallyinvasivetechniques,off-pumpsurgeryandtotal'arterialrevascularizationhavefotmdrolesinthesurgicaltreatmentofpatientswithcoronaryarterydisease.Thecontinueddevelopmentofthetechniquesofpercutaneouscoronaryintervention(PCI)isalsohavinganimpactonthetypeofpatientreferredforCABG.

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：Treatmentofpancreaticcancerismultimodalandsurgeryisanessentialpart,mandatoryforcurativepotential.Alsochemotherapyisessential,andseriouspostoperativecomplicationsorrapiddiseaseprogressionmayprecludecompletionofmultimodaltreatment.Thesequenceoftreatmentinterventionshasthereforebecomeanimportantconcern,andnumerousongoingrandomizedcontrolledtrialscompareclinicaloutcomeafterupfrontsurgeryandneoadjuvanttreatmentwithsubsequentresection.Inpreviousyears,borderlineresectableandlocallyadvancedpancreaticcancerwasmostoftenconsideredunresectable.Moreeffectivechemotherapytogetherwiththelatestimprovementsinsurgicalexpertisehasresultedinextendedoperations,pushingthebordersofresectability.Multivisceralresectionswithorwithoutresectionofmajormesen-tericvesselsarenowperformedinnumerouspatients,resultinginbetteroutcome,recordedasoverallsurvivaland/orpatientreportedoutcome.Butpostoperativemorbidityincreasesconcurrently,andclinicalbenefitmustbecarefullyevaluatedagainstriskofpotentialharm,associatedwithnewcomprehensivemultimodaltreatmentsequences.Eventhoughcost/utilityanalysesaredeficient,extendedsurgeryhasresultedinsignifi-cantlylongerandbetterlifeformanypatientswithnoothertreatmentalternative.Improvedselectionofpatientstosurgeryand/orchemotherapywillinthenearfuturebepossible,basedonbettertumorbiologyinsight.Clinicallyavailablebiomarkersenablingpersonalizedtreatmentareforthcoming,buttheseoptionsarestilllimited.Theimportanceofsurgicalresectionforeachpatient’sprognosisispresentlyincreasing,justifyingsustainedexpansionofthesurgicaltreatmentmodality.

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简介：精索静脉曲张在临床的实践被认出了为在一个世纪。原来，这些过程为疼痛的管理被利用，但是自从1952，修理主要为男不孕的处理。然而，因为pathophysiology不是清楚的，精索静脉曲张的诊断和治疗是争论的，研究的入口标准在中心之中变化了，并且有很少使随机化的临床的试用。不过，临床医生们继续为精索静脉曲张的修正开发技术，基本科学家在精索静脉曲张的pathophysiology上继续调查，并且从未来的使随机化的试用的新结果数据出现在世界的文学。因此，Andrology的亚洲杂志的这个特殊版本被建议报导许多与精索静脉曲张有关的新信息，作为这个工程的特定的部分，现在的文章作为进化的全面评论和校正过程的精炼被开发。

简介：比较在主要debulking外科(PDS)和neoadjuvant化疗之间的幸存和perioperative病态的目的在与先进上皮的卵巢的癌症(EOC)对待病人由间隔debulking外科(NAC/IDS)列在后面。我们回顾地与阶段IIIC或IVEOC考察了67个病人的方法从2006年1月在北京大学癌症医院对待到2009年6月。在那里，37和30个病人分别地经历了PDS和NAC/标志。结果在全面幸存(OS)或没有前进的幸存(PFS)的差别都没在NAC/IDS组和PDS组之间被观察(OS：41.2对39.1个月，P=0.23；PFS：27.1对24.3个月，P=0.37)。最佳的debulking率在NAC/IDS组是60%，它在PDS组(32.4%)(P=0.024)比那显著地高。NAC/IDS组显著地有比PDS的肠的功能的估计的血损失和输送，更低的nasogastricintubation率，和更早的移动和恢复组织的更少的intraoperative(P<0.05)。结论NAC/IDS不比PDS侵略，并且关于最佳的cytoreduction率，intraoperative血损失，和手术后的恢复提供优点，没有显著地损害与在对待有阶段IIIC或IVEOC的病人的PDS相比的幸存。因此，NAC/IDS可以是为EOC病人的一种珍贵治疗选择。

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简介：AbstractPrecision medicine requires coordinated and integrated evidence-based combinatorial approaches so that diagnosis and treatment can be tailored to the individual patient. In this context, the treatment approach to mild obstructive sleep apnea (OSA) is fraught with substantial debate as to what is mild OSA, and as to what constitutes appropriate treatment. As such, it is necessary to first establish a proposed consensus of what criteria need to be employed to reach the diagnosis of mild OSA, and then examine the circumstances under which treatment is indicated, and if so, whether and when anti-inflammatory therapy (AIT), rapid maxillary expansion (RME), and/or myofunctional therapy (MFT) may be indicated.

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