Background: Automated peritoneal dialysis (APD) can cater to individual needs, provide treatment while asleep, take into account the adequacy of dialysis, and improve the quality of life. Currently, independent research and development of APD machines made in China are more conducive to patients. A randomized, multicenter, crossover study was conducted by comparing an APD machine made in China with an imported machine. The safety, effectiveness, and manipulability of the two machines were compared. Methods: Two hundred and sixty patients who underwent peritoneal dialysis (PD) on a regular basis in 18 centers between August 2015 and February 2016 were included. The inclusion criteria include age ≥18 years and PD ≥30 days. The exclusion criteria were as follows: hemodialysis; exit site or tunnel infection; and peritonitis ≤30 days. The patients were randomly divided into Group A, who were first treated with a FM machine made in China, then changed to an imported machine; and Group B, who were treated using the reverse sequence. APD treatment was performed with 10 L/10 h and 5 cycles of exchange. After 72 h, the daily peritoneal Kt/V, the accuracy of the injection rate, accuracy of the injection temperature, safety, and manipulability of the machine were assessed. Noninferiority test was conducted between the two groups. Results: The daily peritoneal Kt/V in the APD machine made in China and the imported APD machine were 0.17 (0.14, 0.25) and 0.16 (0.13, 0.23), respectively. There was no significant difference between the groups (Z = 0.15, P = 0.703). The lower limit of the daily Kt/V difference between the two groups was 0.0069, which was greater than the noninferiority value of -0.07 in this study. The accuracy of the injection rate and injection temperature was 89.7% and 91.5%, respectively, in the domestic APD machine, which were both slightly better than the accuracy rates of 84.0% and 86.8% in the imported APD machine (89.7% vs. 84.0%, P = 0.2466; 91.5% vs. 86.8%, P = 0.0954). Therefore, the APD machine made in China was not inferior to the imported APD machine. The fuselage of the imported APD machine was space-saving, while the APD machine made in China was superior with respect to body mobility, man-machine dialog operation, alarm control, and patient information recognition. Conclusions: The FM machine made in China was not inferior to the imported APD machine. In addition, the FM machine made in China had better operability. Trial Registration Clinicaltrials.gov, NCT02525497; https://clinicaltrials.gov/ct2/results?cond=&term=NCT02525497&cntry=& state=&city=&dist=.
Adult ; China ; Cross-Over Studies ; Female ; Humans ; Male ; Middle Aged ; Multicenter Studies as Topic ; Peritoneal Dialysis ; adverse effects ; instrumentation ; methods ; Quality of Life ; Temperature

Objective: To compare the safety and effectiveness of shovel-shaped electrode transurethral plasmakinetic enucleation of the prostate (PKEP) with those of plasmakinetic resection of the prostate (PKRP) in the treatment of benign prostatic hyperplasia (BPH). METHODS: We retrospectively analyzed the clinical data about 78 BPH patients received in Shanghai Ninth People's Hospital from June 2016 to January 2017, 39 treated by shovel-shaped electrode PKEP and the other 39 by PKRP. We observed the patients for 6 months postoperatively and compared the effects and safety of the two surgical strategies. RESULTS: No statistically significant difference was observed between the PKEP and PKRP groups in the operation time (［69.3 ± 8.8］ vs ［72.2 ± 7.9］ min, P = 0.126), but the former, as compared with the latter, showed a markedly less postoperative loss of hemoglobin (［3.9 ± 2.8］ vs ［13.9 ± 5.2］ g/L, P <0.001) and shorter bladder irrigation time (［12.5 ± 1.2］ vs ［43.4 ± 2.8］ h, P <0.001), catheterization time (［64.0 ± 4.5］ vs ［84.8 ± 3.0］ h, P <0.001) and hospital stay (［3.1 ± 0.3］ vs ［5.5 ± 0.4］ d, P <0.001). There were no statistically significant differences between the PKEP and PKRP groups in the postoperative maximum urinary flow rate (Qmax) (［21.62 ± 1.07］ vs ［21.03 ± 0.96］ ml/s, P = 0.12), International Prostate Symptoms Score (IPSS) (5.85 ± 0.90 vs 6.03 ± 0.81, P = 0.279), quality of life score (QoL) (2.0 ± 0.73 vs 2.28 ± 0.72, P = 0.09), postvoid residual urine volume (PVR) (［19.59 ± 6.01］ vs ［20.21 ± 5.16］ ml, P = 0.629), or the incidence rates of urinary incontinence (2.56% ［1/39］ vs 7.69% ［3/39］, P >0.05) and other postoperative complications. CONCLUSIONS Both PKEP and PKRP are effective methods for the treatment of BPH, but PKEP is worthier of clinical recommendation for a better safety profile, more thorough removal of the prostate tissue, less blood loss, shorter hospital stay, and better improved quality of life of the patient.
China ; Electrodes ; adverse effects ; Equipment Design ; Humans ; Male ; Prostatic Hyperplasia ; surgery ; Quality of Life ; Retrospective Studies ; Transurethral Resection of Prostate ; instrumentation ; methods ; Treatment Outcome

Enteral Nutrition ; instrumentation ; methods ; Female ; Fluoroscopy ; methods ; Gastrostomy ; adverse effects ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Postoperative Complications ; classification ; diagnosis ; therapy ; Reproducibility of Results ; Retrospective Studies ; Singapore ; Surgery, Computer-Assisted ; methods ; Treatment Outcome

Arthroscopy ; adverse effects ; instrumentation ; methods ; Diagnostic Equipment ; adverse effects ; microbiology ; Disinfection ; methods ; Equipment Failure ; Humans ; Materials Testing ; methods ; Orthopedic Equipment ; adverse effects ; microbiology ; Postoperative Complications ; etiology ; prevention & control

Nasal intermittent positive pressure ventilation (NIPPV) can augment nasal continuous positive airway pressure (nCPAP) by delivering intermittent positive pressure ventilation in a noninvasive way and can provide a new option for neonatal noninvasive respiratory support. NIPPV has an advantage over nCPAP in primary and post-extubation respiratory support. Moreover, it can reduce severe apnea of prematurity. Synchronized NIPPV has promising application prospects. This review article summarizes the advances in the application of NIPPV in neonatal respiratory support to promote the understanding and standardization of this technique.
Airway Extubation ; Humans ; Infant, Newborn ; Intermittent Positive-Pressure Ventilation ; adverse effects ; instrumentation ; methods ; Prognosis

To evaluate the efficacy and safety of drug-eluding beads transarterial chemoembolization (DEB-TACE) in treatment of unrecectable hepatocellular carcinoma (HCC).The clinical data of 42 consecutive HCC patients undergoing TACE were retrospectively analyzed, including 20 cases received conventional TACE (cTACE group) and 22 cases received TACE with epirubicine-loaded microspheres (CalliSpheres) (DEB-TACE group). MRI scans were performed 1 week before and 1, 3 and 6 months after initial therapy. The response to treatment, disease recurrence, complications and adverse effects were documented and compared between two groups.There were no significant differences in 1-month, 3-month and 6-month objective response rate (CR+PR) and disease control rate (CR+PR+SD), disease recurrence, complications and adverse effects of interventional therapy between cTACE group and DEB-TACE group. Additionally, there were no significant differences about locoregional biliary injuries, intrahepatic biloma, and newly detected intra- or extrahepatic HCC on MRI between cTACE group and DEB-TACE group.There were no statistically significant differences between cTACE group and DEB-TACE group with regard to the short-term response, disease recurrence, complications and side effects. Hepatic-locoregional complications may be more frequent in DEB-TACE group than those in cTACE group.
Carcinoma, Hepatocellular ; diagnostic imaging ; therapy ; Chemoembolization, Therapeutic ; adverse effects ; instrumentation ; methods ; Comparative Effectiveness Research ; Drug Delivery Systems ; instrumentation ; methods ; Epirubicin ; administration & dosage ; therapeutic use ; Humans ; Liver Neoplasms ; Magnetic Resonance Imaging ; Microspheres ; Neoplasm Recurrence, Local ; Retrospective Studies ; Treatment Outcome

Endoscopy plays an important role in the diagnosis and treatment of postoperative complications of gastric cancer. Endoscopic intervention can avoid the second operation and has attracted wide attention. Early gastric anastomotic bleeding after gastrectomy is the most common. With the development of technology, emergency endoscopy and endoscopic hemostasis provide a new treatment approach. According to the specific circumstances, endoscopists can choose metal clamp to stop bleeding, electrocoagulation hemostasis, local injection of epinephrine or sclerotherapy agents, and spraying specific hemostatic agents. Anastomotic fistula is a serious postoperative complication. In addition to endoscopically placing the small intestine nutrition tube for early enteral nutrition support treatment, endoscopic treatment, including stent, metal clip, OTSC, and Over-stitch suture system, can be chosen to close fistula. For anastomotic obstruction or stricture, endoscopic balloon or probe expansion and stent placement can be chosen. For esophageal anastomotic intractable obstruction after gastroesophageal surgery, radial incision of obstruction by the hook knife or IT knife, a new method named ERI, is a good choice. Bile leakage caused by bile duct injury can be treated by placing the stent or nasal bile duct. In addition, endoscopic methods are widely used as follows: abdominal abscess can be treated by the direct intervention under endoscopy; adhesive ileus can be treated by placing the catheter under the guidance of endoscopy to attract pressure; alkaline reflux gastritis can be rapidly diagnosed by endoscopy; gastric outlet obstruction mainly caused by cancer recurrence can be relieved by metal stent placement and the combination of endoscopy and X-ray can increase success rate; pyloric dysfunction and spasm caused by the vagus nerve injury during proximal gastrectomy can be treated by endoscopic pyloromyotomy, a new method named G-POEM, and the short-term outcomes are significant. Endoscopic submucosal dissection (ESD) allows complete resection of residual gastric precancerous lesions, however it should be performed by the experienced endoscopists.
Anastomosis, Surgical ; adverse effects ; Bile Ducts ; injuries ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Fistula ; etiology ; therapy ; Duodenogastric Reflux ; diagnostic imaging ; etiology ; Endoscopy, Gastrointestinal ; methods ; Enteral Nutrition ; instrumentation ; methods ; Female ; Gastrectomy ; adverse effects ; Gastric Outlet Obstruction ; surgery ; Gastritis ; diagnosis ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Hemostasis, Endoscopic ; methods ; Hemostatics ; administration & dosage ; therapeutic use ; Humans ; Male ; Neoplasm Recurrence, Local ; surgery ; Postoperative Complications ; diagnosis ; therapy ; Precancerous Conditions ; surgery ; Pylorus ; innervation ; physiopathology ; surgery ; Stents ; Stomach Neoplasms ; complications ; surgery ; Treatment Outcome ; Vagus Nerve Injuries ; etiology ; surgery

Incidence of gastric cancer is high in China and standard radical operation is currently the main treatment for gastric cancer. Postoperative complications, especially some special complications, can directly affect the prognosis of patients, even result in the increase of mortality. But the incidences of these special complications are low, so these complications are often misdiagnosed and delayed in treatment owing to insufficient recognition of medical staff. These special complications include (1) Peterson hernia: It is an abdominal hernia developed in the space between Roux loop and transverse colon mesentery after Roux-Y reconstruction of digestive tract. Peterson hernia is rare and can quickly result in gangrenous ileus. Because of low incidence and without specific clinical symptoms, this hernia does not attract enough attention in clinical practice, so the outcome will be very serious. Once the diagnosis is made, an emergent operation must be performed immediately. Peterson space should be closed routinely in order to avoid the development of hernia. (2) Lymphatic leakage: It is also called chyle leakage. Cisterna chylus is formed by gradual concentration of extensive lymphatic net to diaphragm angle within abdominal cavity. Lymphadenectomy during operation may easily damage lymphatic net and result in leakage. The use of ultrasonic scalpel can decrease the risk of lymphatic leakage in certain degree. If lymphatic leakage is found during operation, transfixion should be performed in time. Treatment includes total parenteral nutrition, maintenance of internal environment, supplement of protein, and observation by clamp as an attempt. (3)Duodenal stump leakage: It is one of serious complications affecting the recovery and leading to death after subtotal gastrectomy. Correct management of duodenal stump during operation is one of key points of the prevention of duodenal stump leakage. Routine purse embedding of duodenal stump is recommend during operation. The key treatment of this complication is to promt diagnosis and effective hemostasis.(4) Blood supply disorder of Roux-Y intestinal loop: Main preventive principle of this complication is to pay attention to the blood supply of vascular arch in intestinal edge. (5) Anastomotic obstruction by big purse of jejunal stump: When Roux-en-Y anastomosis is performed after distal radical operation for gastric cancer, anvil is placed in the remnant stomach and anastomat from distal jejunal stump is placed to make gastrojejunal anastomosis, and the stump is closed with big purse embedding. The embedding jejunal stump may enter gastric cavity leading to internal hernia and anastomotic obstruction. We suggest that application of interruptable and interlocking suture and fixation of stump on the gastric wall can avoid the development of this complication.
Anastomosis, Roux-en-Y ; adverse effects ; China ; Chylous Ascites ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; surgery ; Gastrectomy ; adverse effects ; methods ; mortality ; Gastric Outlet Obstruction ; etiology ; prevention & control ; Gastric Stump ; surgery ; Hemostatic Techniques ; Hernia ; etiology ; prevention & control ; therapy ; High-Intensity Focused Ultrasound Ablation ; instrumentation ; Humans ; Jejunum ; blood supply ; surgery ; Lymph Node Excision ; adverse effects ; instrumentation ; Lymphatic System ; injuries ; Postoperative Complications ; classification ; diagnosis ; mortality ; prevention & control ; Prognosis ; Stomach ; surgery ; Stomach Neoplasms ; complications ; surgery ; Suture Techniques ; standards ; Thoracic Duct ; injuries ; Wound Closure Techniques ; standards

With the rapid advancement of minimally invasive new technology, laparoscopic surgery and robotic surgery are now regarded as the main direction in surgical treatment for stomach cancers. Recent evidence has confirmed the safety and feasibility of laparoscopic surgery for early gastric cancer and advanced gastric cancer. However, gastrointestinal surgeons should pay more attention to complications after laparoscopic gastrectomy because of rich blood supply, complex tissue layers and lymph node metastasis. Common complications related to laparoscopic surgery are associated with laparoscopic instruments and operating, intra-abdominal bleeding, anastomotic leakage, anastomotic bleeding, pancreatic leakage, duodenal stump leakage, lymphatic leakage and so on. This article mainly focuses on the causes, prevention and treatment of the complications after laparoscopic gastrectomy.
Anastomotic Leak ; Duodenal Diseases ; Female ; Gastrectomy ; adverse effects ; instrumentation ; methods ; Humans ; Laparoscopy ; adverse effects ; instrumentation ; methods ; Lymphatic Metastasis ; Male ; Postoperative Complications ; etiology ; prevention & control ; therapy ; Robotic Surgical Procedures ; adverse effects ; instrumentation ; methods ; Stomach Neoplasms ; complications ; surgery

D2 lymphadenectomy is currently the worldwide standard operation for locally advanced gastric cancer and D2+ is an option for some selected patients. The D2 plus lymphadenectomy includes No.8p, No.10, No.11d, No.12b, No.12p, No.13, No.14v, No.16a2 and No.16b1. Dissection of these groups of lymph nodes may cause related complications. Postoperative complications that can cause prolonged inflammation have significant impact not only on mortality but also on overall survival of patients with gastric cancer even if the tumor is resected curatively. D2 plus lymphadenectomy is recommended only in high volume medical center by experienced surgeon. The adequate exposure of the operative field, right anatomical space, use of ultrasound scalpel and operator with enough patience are proved to be pivotal to prevent the complications.
High-Intensity Focused Ultrasound Ablation ; instrumentation ; Humans ; Inflammation ; prevention & control ; Long Term Adverse Effects ; prevention & control ; Lymph Node Excision ; adverse effects ; instrumentation ; methods ; mortality ; Lymph Nodes ; Postoperative Complications ; prevention & control ; Stomach Neoplasms ; mortality ; surgery ; Surgical Instruments