Objective To investigate the effects of endotracheal suctioning,turning over,oral caring and swallowingon cuff pressure,so as to provide evidence for the management of the endotracheal cuff.Methods During continuous monitoring of cuff pressure with pressure sensor,the changes of cuff pressure were recorded in the process of endotracheal suctioning,turning over,and oral caring.The data of cuff pressure were recorded including before activity,during activity,after activity for 5 min,15 min and 30 min.In addition,the data of cuff pressure were recorded including before swallowing,during swallowing,after swallowing for 1 min,5 min and 10 min.Results The cuff pressure during endotracheal suctioning and after endotracheal suctioning for 5 min was higher than that before endotracheal suctioning,the difference was statistically significant (P＜0.05);the cuff pressure during turning over and after turning over for 5 min was higher than that before turning over,the difference was statistically significant (P＜0.05);the cuff pressure during the oral caring was higher than that before oral caring,the difference was statistically significant(P＜0.05);the cuff pressure during swallowing was higher than that before swallowing,the difference was statistically significant(P＜0.05).Conclusion These clinical factors would lead to transient increase of cuff pressure including suctioning,turning over,oral caring,and swallowing.The instantaneous cuff pressure will mislead the staff to judge the safey of endotracheal cuff.The cuff pressure should not be blindly adjusted,so as to avoid the risks of leakage and aspiration.

Objectives To compare endovascular aortic repair (EVR) and medical therapy for acute type B aortic dissection (AD) in terms of treatment results.Methods From January 2004 to October 2010 116 cases were collected and were divided into two groups,with treatment of EVR (n =60)and medical therapy (n ＝ 56).Treatment outcomes were assessed.Results Clinical manifestations of AD are complex and variable,with the most common symptom being pain on chest and back (74.1％).CTA is the most valuable method in confirming the diagnosis of aortic dissection.In conservative group of 56 patients admitted to hospital,30-day mortality rate was 16.1％.In EVR group of 60 patients with grafts successfully released,the 30-day mortality was 1.7％.There is significant difference between the two groups on mortality rate during 30-day(P ＜0.05).Follow-up rate in conservative group and the EVR group was 71.4％ and 86.7％,with average follow-up time of (38 ± 16) months and (35 ± 14) months.The 5-year survival rates were 87.5％ and 88.5％ respectively in conservative group and EVR group (P ＞ 0.05).Conclusions EVR is considered to be the first choice for acute Stanford type B dissection.EVR can improve patients' 30-day survival,though long term result is comparable with that of conservative treatment.

Objective:To assess the effects of not monitoring gastric residual volume compared to the routine monitoring gastric residual volume on the risk of ventilator-associated pneumonia.Methods:A systematic literature search of PubMed, EMBASE, Cochrane Library, CNKI, CBM and WanFang Database was conducted from inception up to January 2019.Two independent reviewers screened potentially eligible articles, selected eligible studies and abstracted pertinent data. Relative risk ( RR), weighted mean difference ( MD), and 95% confidence interval (95% CI) were calculated and heterogeneity was assessed with the I2test. Results:Four studies with a total of 785 patients were included in this meta-analysis. No monitoring gastric residual volume did not significantly increase the incidence of ventilator-associated pneumonia ( RR=1.30, 95% CI 0.78-2.16, P=0.32), compared with monitoring gastric residual volume. However, the incidence of vomiting in the no monitoring gastric residual volume group is higher ( RR=1.52, 95% CI 1.20-1.91, P=0.000 4). Not monitoring gastric residual volume decreased the rate of feeding intolerance in critically ill patients ( RR=0.61, 95% CI 0.51-0.72, P<0.01).There were no differences in the duration of mechanical ventilation ( MD=0.39, 95% CI -0.70-1.47, P=0.49) and ICU length of stay ( MD=-0.19, 95% CI -1.55--1.16, P=0.78). Conclusion:The absence of monitoring gastric residual volume did not increase the risk of ventilator-associated pneumonia in critically patient with mechanical ventilation. Gastric residual volume monitoring can not be used as a maker to prevent aspiration and to assess feeding intolerance. We still need to conduct large-scale,well-desighed clinical trials to verify whether gastric residual volume monitoring can be eliminated.

Objective:To evaluate the effect of oropharyngeal aspiration on reducing ventilator-associated pneumonia,in order to provide a basis for clinical operation and practice.Methods:CNKI, Wanfang, China Biology Medicine Disc, VIP, PubMed, Embase, Cochrane Library, Web of Science and CINAHL databases were searched for relevant studies on the effects of oropharyngeal attraction on ventilators associated pneumonia. At the same time, the included references were screened, and the search time limit was from the establishment of the database to January 1, 2023. The quality of the included literature was strictly evaluated and data extracted by two researchers with evidence-based training, and Meta-analysis was performed by RevMan 5.4 software.Results:The results of meta-analysis showed that oropharyngeal aspiration could reduce the incidence of ventilator-associated pneumonia ( OR=0.30, 95% CI 0.22-0.40, P<0.01) and shorten the duration of mechanical ventilation ( MD=-2.39, 95% CI -3.59--1.20, P<0.01) and reduced length of stay in ICU ( MD=-2.62, 95% CI -2.99--2.26, P<0.01). Conclusions:Strengthening oropharyngeal aspiration can reduce the incidence of ventilator-associated pneumonia in patients with mechanical ventilation. In clinical practice, oropharyngeal aspiration should be performed when the position changes, and continuous aspiration can be performed if conditions are met.

OBJECTIVETo evaluate the efficacy and safety of trastuzumab combined with chemotherapy in the treatment for HER-2-positive chemo-refractory advanced gastric or gastro-esophageal junction adenocarcinoma.

METHODSTwenty consecutive cases of chemo-refractory advanced gastric or gastro-esophageal junction adenocarcinoma treated in Peking University Cancer Hospital between 2009 June and 2013 August were included in this study. The patients with adenocarcinoma were previously confirmed and were eligible if their tumor showed overexpression of HER-2+++ by immunohistochemistry or HER-2 gene amplification-positive by FISH, and if they failed to at least one previous chemotherapy. Response and toxicities were evaluated with RECIST 1.0 and CTC AE 3.0 criteria.

RESULTSThe twenty patients received trastuzumab plus second- or later-line chemotherapy, consisting of nine platinum with fluoropyrimidines, five paclitaxel with fluoropyrimidines, three fluoropyrimidines monotherapy, two irinotecan monotherapy, and one docetaxel monotherapy. In these 20 cases, 3 PR (15.0%) and 10 SD (50.0%) were achieved, with a disease control rate of 65.0%. The median PFS was 6.1 months (95%CI 3.0-9.2) and median OS was 11.1 months (95%CI 8.4-13.7). The median cycle number of Trastuzumab administration was 6.5. The patients treated with Trastuzumab ≥ 6 times had a median OS of 13.8 months, significantly longer than that of 9.5 months in the patients treated <6 times (P < 0.001). The patients treated with Trastuzumab ≥ 6 times had a median PFS of 7.8 months, significantly longer than that of 3.7 months in patients treated <6 times (P = 0.029). Among the 20 cases, loss of appetite (13 cases of grade 1-2), neutropenia (12 cases of grade 1-2 and 3 cases of grade 3-4) and fatigue (9 cases of grade 1-2 and 3 cases of grade 3-4) were the most frequent adverse events. No cardiac events including asymptomatic decreases in LVEF ≥ 10% and no treatment-related death were recorded.

CONCLUSIONSCombination of trastuzumab with chemotherapy is effective and safe in patients with HER2-positive advanced chemo-refractory gastric or gastro-esophageal junction adenocarninoma. However, prospective studies are warranted to further confirm its efficacy and safety.

Adenocarcinoma ; drug therapy ; metabolism ; secondary ; surgery ; Adult ; Aged ; Anorexia ; chemically induced ; Antibodies, Monoclonal, Humanized ; administration & dosage ; adverse effects ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Camptothecin ; administration & dosage ; adverse effects ; analogs & derivatives ; Cisplatin ; administration & dosage ; adverse effects ; Disease Progression ; Disease-Free Survival ; Drug Resistance, Neoplasm ; Esophagogastric Junction ; Fatigue ; chemically induced ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; Male ; Middle Aged ; Neutropenia ; chemically induced ; Paclitaxel ; administration & dosage ; adverse effects ; Pyrimidines ; administration & dosage ; adverse effects ; Receptor, ErbB-2 ; metabolism ; Remission Induction ; Retrospective Studies ; Stomach Neoplasms ; drug therapy ; metabolism ; secondary ; surgery ; Survival Rate ; Trastuzumab