Objective:To investigate the effect of power PICC with two different external lengths in patients with hematologic diseases.Methods:From August 2020 to August 2021, a retrospective analysis was conducted on 233 cases of hematologic diseases who received power PICC catheterization in Department of Hematology, the Nanfang Hospital of Southern Medical University, the patients were divided into 0-1 cm group (132 cases) and 2-4 cm group (101 cases) according to the external lengths after catheter insertion. The incidence of related complications and patient comfort at 24 hours, 72 hours, 7 days and 14 days after catheterization were compared between the two groups.Results:At 24 hours and 72 hours after catheterization, the incidence of bleeding at puncture point in 0-1 cm group was 14.39%(19/132) and 9.85%(13/132), in 2-4 cm group was 30.69%(31/101) and 32.67%(33/101), the difference was statistically significant ( χ2=9.02, 14.16, both P<0.05). The rate of redness and swelling of punture point at 7 days after catheterization was 9.09%(12/132) and 40.59%(41/101) in the two groups, with statistical significance ( χ2=32.32, P<0.05). The rates of slightly prolapse at 7 and 14 days after catheterization were 18.18% (24/132) and 18.94%(25/132) in 0-1 cm group, 59.41% (60/101) and 67.33%(68/101) in 2-4 cm group, the difference between the two groups was statistically significant ( χ2=42.18, 55.86, both P<0.05). In the observation of comfort at 14 days after catheterization, the comfort score of patients in the 0-1 cm group was significantly higher than that in the 2-4 cm group, and the difference between the two groups was statistically significant ( χ2=7.34, P<0.05). Conclusions:Patients with hematologic diseases can reduce the risk of bleeding and slightly prolapse, and improve the comfort of patients when the external lengths is 0-1 cm of power PICC, which is worthy of clinical application and promotion. The catheterizer should adopt accurate in appropriate measurement method to determine the best lengths of the catheters.

BACKGROUND: Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion. METHODS: Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test). RESULTS: We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies. CONCLUSION: The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION ClinicalTrials.gov, NCT01597232.
Humans ; Adult ; Postoperative Complications ; Erythrocyte Transfusion/adverse effects* ; Blood Transfusion ; Hospitals ; Hemoglobins/analysis*

Objective:To compare the efficacy and safety of endoscopic sclerotherapy with polycinnamol solution and foam in the treatment of grade II hemorrhagic internal hemorrhoids.Methods:From September 2020 to June 2021, 81 patients with grade II hemorrhagic internal hemorrhoids were collected from the Department of Gastroenterology, the First Affiliated Hospital of University of Science and Technology of China. They were randomly divided into an observation group and a control group. The observation group was injected with polycinnamol solution, and the control group was injected with polycinnamol foam. All of them were treated with endoscopic sclerotherapy. The clinical data of the two groups were compared and analyzed. The operation time, immediate hemostasis rate, incidence of postoperative complications (such as fever, pain, bleeding and Urinary retention), recurrence and rebleeding rate of the two groups were observed, and the efficacy and safety of the two groups in the treatment of grade II hemorrhagic internal hemorrhoids were compared.Results:There was no statistically significant difference in basic data between the two groups of patients (all P>0.05), indicating comparability. The surgical operation time of the observation group patients [(7.40±1.18)min] was shorter than that of the control group [(13.88±0.95)min] ( P<0.05); The injection dose of polycinnamol [(5.79±1.61)ml] in the observation group was higher than that in the control group [(4.38±1.92)ml] ( P<0.05). The immediate postoperative hemostasis rate in the observation group was the same as that in the control group (100%). The incidence of postoperative fever (7.32%), perianal pain (4.88%), bleeding (7.32%), and urinary retention (4.88%) complications in the observation group had no significant difference from that in the control group [postoperative fever (5.00%), anal pain (7.50%), bleeding (7.50%), and urinary retention (2.50%)] (all P>0.05). Two months after surgery, the rebleeding rate in the observation group (4.88%) was not significantly different from that in the control group (7.50%) ( P>0.05), but the rebleeding score in the observation group (1.21±0.63) was lower than that in the control group (2.62±0.71), with a statistically significant difference ( P<0.05). The rebleeding rate (2.44%) and the rebleeding score (2.33±1.51) in the observation group were lower than those in the control group [the rebleeding rate (12.50%) and the rebleeding score (5.54±2.42)] at 12 months after follow-up, and the differences were statistically significant ( P<0.05). Conclusions:Endoscopic sclerotherapy is effective in the treatment of grade II hemorrhagic internal hemorrhoids. There is no significant difference in the immediate and short-term hemostasis rate and the incidence of complications between two different dosage forms of sclerotherapy, namely, polycinnamol solution and foam, but the operation of the solution injection is more time-saving and the long-term recurrence rate is lower, which is worthy of clinical application.

Objective:To evaluate the effect of paravertebral nerve block (PVNB) combined with general anesthesia on intraoperative regional cerebral oxygen saturation (rScO 2) in elderly patients undergoing thoracoscopic lobectomy. Methods:Seventy American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 60-85 yr, with body mass index of 18-25 kg/m 2, were divided into 2 groups ( n=35 each) using a random number table method: general anesthesia group (group G) and PVNB combined with general anesthesia group (group PG). PVNB was performed at T 4 and T 6 with 0.5% ropivocaine 10 ml for each site under ultrasound guidance before induction of anesthesia in group PG.After induction of anesthesia, anesthesia was maintained with IV propofol and remifentanil, and a patient-controlled intravenous analgesia pump was connected at the end of operation.The maximum and minimum rScO 2 and cumulative time of rScO 2 below the baseline value were recorded.The rScO 2 was recorded before anesthesia (T 0), at 5 min before one-lung ventilation (T 1), at 5 min after one-lung ventilation (T 2) and at tracheal extubation (T 3). The length of postoperative hospital stay and complications within 30 days after operation were recorded. Results:Compared with group G, the minimum rScO 2 and rScO 2 at T 2 and T 3 were significantly increased, the incidence of postoperative cognitive dysfunction was reduced ( P<0.05), and no significant change was found in the other parameters mentioned above in group PG ( P>0.05). Conclusion:PVNB combined with general anesthesia can improve intraoperative rScO 2 and reduce the development of postoperative cognitive dysfunction in elderly patients undergoing thoracoscopic lobectomy.

Fecal incontinence is a very common problem in critically ill and elderly patients and long-term hospitalized bedridden patients, which can easily cause complications such as perianal dermatitis, pressure ulcers and infections, increase patient suffering, and increase medical expenses. Devices that effectively transfer or drain feces are critical to reducing complications after fecal incontinence. This article uses this as a starting point to summarize the main components, current status of use and evaluation indicators of built-in drainage devices at home and abroad, which provides a reference for the development of more scientific and feasible auxiliary tools for fecal incontinence.

Objective:To identify the risk factors for decrease in regional cerebral oxygen saturation (rScO 2) during one-lung ventilation (OLV) in the patients undergoing thoracic surgery. Methods:A total of 175 patients of both sexes, aged ≥55 yr, with expected operation time≥2 h, scheduled for elective thoracic surgery with OLV, were selected in the Fourth Hospital of Hebei Medical University from August 2017 to September 2018.The rScO 2 was continuously monitored from the beginning of anesthesia induction until removal of tracheal intubation.General anesthesia, general anesthesia combined with epidural block or general anesthesia combined with local nerve block were used.The baseline characteristics, previous medical history and history of anesthesia surgery, type of surgery, method of anesthesia, duration of anesthesia, duration of OLV, duration of surgery, and intraoperative adverse events (hypoxemia, hypotension, bradycardia, etc.) were recorded.According to whether a decrease in rScO 2 occurred during OLV (absolute value of rScO 2 was less than 65% or a decrease of more than 20% of the baseline value), the patients were divided into 2 groups: low rScO 2 group and normal rScO 2 group.Multivariate logistic regression analysis was used to identify the risk factors for decrease in rScO 2 during OLV. Results:One hundred and seven patients developed decrease in rScO 2 during OLV, with an incidence of 61.1%.The results of logistic regression analysis showed that hypoxemia was an independent risk factor for decrease in rScO 2, and general anesthesia combined with epidural block was a protective factor for decrease in rScO 2 during OLV. Conclusion:Hypoxemia is an independent risk factor for decrease in rScO 2 during OLV, while general anesthesia combined with epidural block is a protective factor for decrease in rScO 2 in the patients undergoing thoracic surgery.

Objective:To evaluate the effect of edaravone on long-term cognitive function in elderly patients undergoing hip replacement.Methods:A total of 160 patients, aged≥65 yr, undergoing elective hip replacement, were divided into 2 groups ( n=80 each) using the random sequence generated by the McLeod-modified Wichmann-Hill pseudo-random number generator: edaravone group (group E) and control group (group C). Spinal-epidural anesthesia was applied in two groups.Edaravone 60 mg (in 100 ml of normal saline, infusion rate 200 ml/h) was intravenously infused from the time point immediately after achieving the anesthesia plane until the following 30 min.Serum chemokine ligand 13 (CXCL13) and interleukin-6 (IL-6) concentrations were detected by enzyme-linked immunosorbent assay before anesthesia, during surgery (30 min after skin incision), and at postoperative days 1, 3 and 7.The Confusion Assessment Method Scale in Chinese was used to detect the postoperative delirium at postoperative days 1, 2, 3 and 7, and the Telephone Interview for Cognitive Status-Modified and ADL score were adopted to assess the cognitive function and quality of daily living, respectively, and the occurrence of cognitive impairment was recorded at 1 and 12 months after surgery. Results:Compared with group C, the total Telephone Interview for Cognitive Status-Modified score and ADL score were significantly increased, the incidence of postoperative delirium and cognitive impairment was decreased, and the serum CXCL13 and IL-6 concentrations were decreased during surgery and at each time point after surgery in group E ( P<0.05). Conclusion:Edaravone can reduce inflammatory responses and improve long-term cognitive function in elderly patients undergoing hip replacement.

Objective:To evaluate the accuracy of surgical pleth index (SPI) in monitoring the depth of anesthesia in elderly patients undergoing general anesthesia.Methods:Thirty-five patients, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 65-80 yr, with body mass index of 18-30 kg/m 2, scheduled for elective gynecological laparoscopic surgery, were studied.Combined intravenous-inhalational anesthesia was used to maintain bispectral index value at 45-60.SPI was recorded within 2 min before and after skin incision, before and after pneumoperitoneum, and before and after the most intense stimulation of skin incision.The maximum value (SPI max) within 2 min after noxious stimulation was recorded, and the difference between SPI max and baseline value (ΔSPI) was calculated.The receiver operating characteristic curve (ROC) was used to evaluate the accuracy of the above indicators in monitoring the depth of anesthesia. Results:Thirty patients were finally included in this study.The area under the curve of SPI max was 0.887, the diagnostic threshold was 57, the sensitivity was 68.9%, and the specificity was 92.9%.The area under the curve of ΔSPI was 0.988, diagnostic threshold was 12, the sensitivity was 88.0%, and the specificity was 98.7%. Conclusion:SPI can accurately determine the depth of anesthesia in elderly patients with general anesthesia, and using ΔSPI has more clinical significance.

Objective The evaluation index system of quality of assisted fertility treatment care was constructed to provide the basis for scientific evaluation of quality of care in reproductive center. Methods Based on the structure-process-outcome (SPO) quality model, evaluation index system for fertility treatment care in the reproductive center was constructed by literature query, field process tracking, Delphi expert consultation and analytic hierarchy process (AHP). Results The effective recovery rate ( RR ) of the two rounds of the questionnaire was 100% . The expert authority coefficient Cr values were 0.813, 0.845 respectively. The W value of the coordination coefficient was 0.331, 0.372, both of which were statistically significant (P<0.01). Finally, an evaluation index system of quality of assisted fertility treatment care with three dimensions, 14 secondary indicators and 47 items was formed. Yaaph software was used to determine the weight coefficients of primary and secondary indicators, and the consistency test ( Cr<0.1) was performed, and the variation coefficients of all tertiary items were <0.20. Conclusions The weight of the quality index system of assisted reproductive treatment care in reproductive center is reasonable, the indicators were clear, systematic and objective, and worthy of clinical promotion.

Objective To study the distribution of the regions of ultrasound-guided erector spinae plane block (ESPB) at the level of T5 transverse process.Methods Thirty male patients,aged 18-64 yr,with body mass index of 18-24 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective thoracotomy,were enrolled in this study.ESPB was conducted with 0.5％ ropivacaine hydrochloride 0.4 ml/kg at the level of T5 transverse process under ultrasound guidance before induction of general anesthesia.Blocks in each thorax and back region (the left side of the body was divided into 18 different regions based on the anatomical "landmarks" on the body surface,No.1-18) were assessed by cold stimulation.Effective block in each region was recorded at 10,15,20,25,30,40 and 50 min after administration.The adverse reactions such as pneumothorax,puncture hematoma and local anesthetic intoxication were recorded.Results The blocking range was basically fixed at 30 min after a single ESPB injection at the level of T5 transverse process,and the regions covered from the sternal angle to the level of the rib arch.The regions of effective block were No.1-3 and 5-7 in ≥95％ patients,and the regions of effective block were No.1-15 and 17 in patients ≥90％ and ＜ 95％.No patients developed adverse reactions such as pneumothorax,puncture hematoma or local anesthetic intoxication.Conclusion The regions of effective ultrasound-guided ESPB at the level of T5 transverse process are mainly distributed in T2-T8 thoracodorsal skin areas.