Traditionally, urologists recommend an interval of at least 4 weeks after prostate biopsy before radical prostatectomy. The aim of our study was to evaluate whether the interval from prostate biopsy to radical prostatectomy affects immediate operative outcomes, with a focus on differences in surgical approach. The study population of 1,848 radical prostatectomy patients was divided into two groups according to the surgical approach: open or minimally invasive. Open group included perineal and retropubic approach, and minimally invasive group included laparoscopic and robotic approach. The cut-off of the biopsy-to-surgery interval was 4 weeks. Positive surgical margin status, operative time and estimated blood loss were evaluated as endpoint parameters. In the open group, there were significant differences in operative time and estimated blood loss between the <4-week and > or =4-week interval subgroups, but there was no difference in positive margin rate. In the minimally invasive group, there were no differences in the three outcome parameters between the two subgroups. Multivariate analysis revealed that the biopsy-to-surgery interval was not a significant factor affecting immediate operative outcomes in both open and minimally invasive groups, with the exception of the interval > or =4 weeks as a significant factor decreasing operative time in the minimally invasive group. In conclusion, performing open or minimally invasive radical prostatectomy within 4 weeks of prostate biopsy is feasible for both approaches, and is even beneficial for minimally invasive radical prostatectomy to reduce operative time.
Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/*statistics & numerical data ; *Operative Time ; Postoperative Hemorrhage/*epidemiology ; Prevalence ; Prostatectomy/*statistics & numerical data ; Prostatic Neoplasms/epidemiology/*pathology/*surgery ; Republic of Korea/epidemiology ; Retrospective Studies ; Time-to-Treatment/*statistics & numerical data ; Treatment Outcome

To date, the efficacy of radical surgery (RS) versus conservative surgery (CS) for liver hydatid cysts (LHC) remains controversial. This meta-analysis was conducted to compare the two interventions. PubMed, Embase, and Web of Science were searched from their inceptions until June 2016. Meta-analysis was performed using STATA 12.0 software. We identified 19 eligible studies from 10 countries by retrieval. In total, 1853 LHC patients who received RS were compared with 2274 patients treated by CS. The risk of postoperative overall complication, biliary fistula, and recurrence was significantly lower, and operation time was significantly longer in the RS group. However, no statistically significant differences were found in terms of mortality risk and the duration of hospital stay between RS and CS. No significant publication biases were observed in all the above analyses. In conclusion, RS reduces the rates of postoperative complications and recurrence, whereas no trend toward such a reduction in mortality was observed in LHC patients.
Echinococcosis, Hepatic ; mortality ; surgery ; Humans ; Length of Stay ; statistics & numerical data ; Operative Time ; Postoperative Complications ; epidemiology ; Recurrence ; Treatment Outcome

BACKGROUNDPrimary percutaneous coronary intervention (PCI) has been clearly identified as the first therapeutic option for patients with acute ST-segment elevation myocardial infarction (STEMI). The importance of reducing door-to-balloon (D2B) time has gained increased recognition. This study aimed to assess the feasibility, safety and efficacy of the strategy of direct ambulance transportation of patients with acute STEMI to catheterization lab to receive primary PCI.

METHODSThe study population included 141 consecutive patients with chest pain and ST-segment elevation who were admitted to the catheterization laboratory directly by the ambulance and underwent primary PCI (DIRECT group). Another 145 patients with STEMI randomly selected from the PCI database, were served as control group (conventional group); they were transported to catheterization laboratory from emergency room (ER). The primary endpoint of D2B time, and secondary endpoint of in-hospital and 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization) were compared.

RESULTSBaseline and procedural characteristics between the two groups were comparable, except more patients in the DIRECT group presented TIMI 0-1 flow in culprit vessel at initial angiogram (80.1% and 73.8%, P = 0.04). Comparing to conventional group, the primary endpoint of D2B time was reduced ((54 ± 18) minutes and (112 ± 55) minutes, P < 0.0001) and the percentage of patients with D2B < 90 minutes was increased in the DIRECT group (96.9% and 27.0%, P < 0.0001). The success rate of primary PCI with stent implantation with final Thrombolysis in Myocardial Infarction (TIMI) 3 flow was significantly higher in the DIRECT group (93.8% and 85.2%, P = 0.03). Although no significant difference was found at 30-day MACE free survival rate between the two groups (95.0% and 89.0%, P = 0.06), a trend in improving survival status in the DIRECT group was demonstrated by Kaplan-Meier analysis.

CONCLUSIONDirect ambulance transport of STEMI patients to the catheterization laboratory could significantly reduce D2B time and improve success rate of primary PCI and 30-day clinical outcomes.

Aged ; Ambulances ; statistics & numerical data ; Angioplasty, Balloon, Coronary ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; therapy ; Prospective Studies ; Time Factors ; Treatment Outcome

Aged ; Ambulances ; statistics & numerical data ; Angioplasty, Balloon, Coronary ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; therapy ; Prospective Studies ; Time Factors ; Treatment Outcome

No abstract available.
Female ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Male ; Patient Readmission/*statistics & numerical data ; Peptic Ulcer/*epidemiology ; Time-to-Treatment/*statistics & numerical data

OBJECTIVE: To compare the time delay between in-hospital stroke and out-of-hospital stroke patients, and to explore the influence factors for the prognosis of in-hospital stroke patients treated by intravenous thrombolysis. METHODS: Clinical data of 3050 patients with ischemic stroke who received intravenous thrombolysis in 71 hospitals in Zhejiang province from June 2017 to September 2018 were analyzed. Differences of time delay including door to imaging time (DIT), imaging to needle time (INT) and door to needle time (DNT) between in-hospital stroke (=101) and out-of-hospital stroke (=2949) were observed. The influencing factors for the outcome at 3 month after intravenous thrombolysis in patients with in-hospital stroke were analyzed using binary logistic regression analysis. RESULTS: Patients with in-hospital stroke had longer DIT[53.5 (32.0-79.8) min vs. 20.0 (14.0-28.0) min, <0.01], longer IDT[47.5(27.3-64.0)min vs. 36.0(24.0-53.0)min, <0.01], and longer DNT[99.0 (70.5-140.5) min vs. 55.0 (41.0-74.0) min, <0.01], compared with patients with out-of-hospital stroke; patients in comprehensive stroke center had longer DIT[59.5(44.5-83.3) min vs. 37.5(16.5-63.5) min, <0.01], longer DNT[110.0(77.0-145.0) min vs. 88.0 (53.8-124.3) min, <0.05], but shorter INT[36.5(23.8-60.3)min vs. 53.5 (34.3-64.8) min, <0.05], compared with patients in primary stroke center. Age (=0.934, 95% 0.882-0.989, <0.05) and baseline National Institute of Health Stroke Scale score (=0.912, 95% 0.855-0.973, <0.01) were independent risk factors for prognosis of in-hospital stroke patients. CONCLUSIONS In-hospital stroke had longer DIT and DNT than out-of-hospital stroke, which suggests that a more smooth thrombolysis process of in-hospital stroke should be established.
Administration, Intravenous ; Brain Ischemia ; drug therapy ; Fibrinolytic Agents ; therapeutic use ; Hospitals ; statistics & numerical data ; Humans ; Prognosis ; Stroke ; drug therapy ; Thrombolytic Therapy ; statistics & numerical data ; Time Factors ; Treatment Outcome

OBJECTIVETo retrospectively investigate the distribution in kidney transplantation for fifteen years in Peking Union Medical College Hospital.

METHODSWe conducted a descriptive research counting up the number of patients who received kidney transplantation each year in our hospital during 1995 and 2010.

RESULTSThe first kidney transplantation in our hospital occurred in the 1960s. The number of kidney transplantation increased until reaching a maximum of 47 grafts in 2001; since then the number fell.

CONCLUSIONSWith the decreased number of kidney transplantation, we have realized the shortage of transplantable organs is very serious. The continuing transplant shortage requires major efforts to expand the donor pool. Donation after cardiac death offers the potential to enlarge the donor pool, but we need to strictly control the criteria for potential donors.

China ; Humans ; Kidney Transplantation ; methods ; statistics & numerical data ; trends ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Time Factors ; Tissue Donors ; statistics & numerical data ; Tissue and Organ Procurement ; statistics & numerical data ; trends ; Treatment Outcome

BACKGROUND/AIMS: The connection between Helicobacter pylori and complicated peptic ulcer disease in peptic ulcer bleeding (PUB) patients taking nonsteroidal anti-inflammatory drugs has not been established. In this study, we sought to determine whether delayed H. pylori eradication therapy in PUB patients increases complicated recurrent peptic ulcers. METHODS: We identified inpatient PUB patients using the Taiwan National Health Insurance Research Database. We categorized patients into early (time lag < or =120 days after peptic ulcer diagnosis) and late H. pylori eradication therapy groups. The Cox proportional hazards model was used. The primary outcome was rehospitalization for patients with complicated recurrent peptic ulcers. RESULTS: Our data indicated that the late H. pylori eradication therapy group had a higher rate of complicated recurrent peptic ulcers (hazard ratio [HR], 1.52; p=0.006), with time lags of more than 120 days. However, our results indicated a similar risk of complicated recurrent peptic ulcers (HR, 1.20; p=0.275) in time lags of more than 1 year and (HR, 1.10; p=0.621) more than 2 years. CONCLUSIONS: H. pylori eradication within 120 days was associated with decreased complicated recurrent peptic ulcers in patients with PUB. We recommend that H. pylori eradication should be conducted within 120 days in patients with PUB.
Adult ; Aged ; Female ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Patient Readmission/*statistics & numerical data ; Peptic Ulcer/complications/*epidemiology/microbiology ; Peptic Ulcer Hemorrhage/complications ; Proportional Hazards Models ; Recurrence ; Time-to-Treatment/*statistics & numerical data ; Treatment Outcome ; Young Adult

INTRODUCTIONThis study aims to study how the effect of the location of patient collapses from cardiac arrest, in the residential and non-residential areas within Singapore, relates to certain survival outcomes.

MATERIALS AND METHODSA retrospective cohort study of data were done from the Cardiac Arrest and Resuscitation Epidemiology (CARE) project. Out-of- hospital cardiac arrest (OHCA) data from October 2001 to October 2004 (CARE) were used. All patients with OHCA as confirmed by the absence of a pulse, unresponsiveness and apnoea were included. All events had occurred in Singapore. Analysis was performed and expressed in terms of the odds ratio (OR) and the corresponding 95% confidence interval (CI).

RESULTSA total of 2375 cases were used for this analysis. Outcomes for OHCA in residential areas were poorer than in non-residential areas-1638 (68.9%) patients collapsed in residential areas, and 14 (0.9%) survived to discharge. This was significantly less than the 2.7% of patients who survived after collapsing in a non-residential area (OR 0.31 [0.16 - 0.62]). Multivariate logistic regression analysis showed that location alone had no independent effect on survival (adjusted OR 1.13 [0.32 - 4.05]); instead, underlying factors such as bystander CPR (OR 3.67 [1.13 - 11.97]) and initial shockable rhythms (OR 6.78 [1.95 - 23.53]) gave rise to better outcomes.

CONCLUSIONEfforts to improve survival from OHCA in residential areas should include increasing CPR by family members, and reducing ambulance response times.

Adult ; Aged ; Aged, 80 and over ; Ambulances ; Cardiopulmonary Resuscitation ; statistics & numerical data ; Cohort Studies ; Emergency Medical Services ; statistics & numerical data ; Female ; Geography ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Out-of-Hospital Cardiac Arrest ; mortality ; Residence Characteristics ; statistics & numerical data ; Retrospective Studies ; Singapore ; epidemiology ; Time-to-Treatment ; statistics & numerical data ; Treatment Outcome

PURPOSE: To compare the efficacy and safety of 23-gauge transconjunctival vitrectomy with the conventional 20-gauge method in idiopathic epiretinal membrane and macular hole surgery. METHODS: Sixty-one consecutive patients undergoing vitrectomy for idiopathic epiretinal membrane and macular hole were recruited to either 20- or 23-gauge vitrectomy groups and prospectively evaluated. Surgical success rates, operating time, surgery-related complications, long-term visual outcomes, and postoperative ocular surface problems are compared in the two groups. RESULTS: There were 31 eyes in the 20-gauge group and 33 eyes in the 23-gauge group. The macular hole closure rate after the first surgery was 83% and 90.9% in the 20-gauge and 23-gauge groups, respectively, with no significant difference between groups (p = 0.59). The success rate for idiopathic epiretinal membranes cases was 100% in both groups. There was no statistically significant difference between overall surgical times (p = 0.90). None of the patients in either group experienced postoperative complications of severe postoperative hypotony, vitreous hemorrhage or endophthalmitis, except one eye in the 20-gauge group, which was found to have retinal detachment. In both groups, statistically significant improvement in visual acuity was achieved 1-month postoperatively (p = 0.002) and thereafter at all postoperative visits (p < 0.05). The mean ocular surface scores were significantly lower in the 23-gauge group at all postoperative visits compared with the 20-gauge group scores (p = 0.001). CONCLUSIONS: Transconjunctival 23-gauge vitrectomy appears to be as effective and safe as conventional 20-gauge vitrectomy in idiopathic epiretinal membrane and macular hole surgeries.
Aged ; Female ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; Prospective Studies ; Retinal Perforations/*surgery ; Statistics, Nonparametric ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods