ObjectiveTo investigate the prevalence of the nutritional risks, the relationship between application of nutritional support and the clinical outcome of patients with gastrointestinal major surgery in the Frist People's Hospital of Shuangliu. MethodsGastrointestinal major surgery patients in Department of General Surgery in the Frist People's Hospital of Shuangliu from March 2010 to March 2014 were consecutively enrolled. Patients who provided informed consent were screened by NRS 2002, tracking nutrition support status and analysis the relationship between nutrition support and clinical outcome. In this study, the clinical outcome index included postoperative complications and hospitalization time. ResultsThere were totally 130 cases enrolled, 112 cases completed assessment by NRS 2002. The prevalence of nutritional risk was 75.9%(85/112), there were totally 57 patients(50.9%) received nutrition support, and all for parenteral nutrition. The prevalence of postoperative complication was 46.4%(52/112). The prevalence of postoperative complication in patients who had nutritional risk and received nutritional support was 41.7%(15/36), whereas, in patients who had nutritional risk but not received nutritional support was 73.5%(36/49), there was statistically significant difference between the 2 groups(P=0.002). In patients who not had nutritional risk, the postoperative complication rate was only 3.7%(1/27). ConclusionsBecause of noninvasive and easy to operate, NRS 2002 are adpted to hospitalized patients with gastrointestinal major surgery. Because of the specific of disease metabolism, the higher nutritional risk occurres in patients with gastrointestinal major surgery, appropriate nutritional support for this kinds of patients can reduce the incidence of postoperative complication, and improve the prognosis.
ObjectiveTo analyze dynamic characteristics of peripheral blood cells in patients with different types of coronavirus disease 2019 (COVID-19), so as to investigate the predictive value of peripheral blood cells and their dynamic changes for clinical outcome of patients with COVID-19.MethodsForty-eight patients with COVID-19 were collected and analyzed from East Hospital of Renmin Hospital of Wuhan University from February 2 to March 15, 2020. These patients were divided into general group (group A, 17 cases), severe survival group (group B, 21 cases), and severe death group (group C, 10 cases). Blood routine examination was done and analyzed before and after admission and among the three groups. The changes of neutrophils and lymphocytes were compared. The predictive power of neutrophils, lymphocytes, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) for clinical outcomes was analyzed through the receiver operating characteristic (ROC) curve.ResultsIn group B, the lymphocyte count at discharge was significantly higher than at admission (P=0.002), and the neutrophil count, NLR and PLR were significantly lower than at admission (P values were 0.012, 0.001 and 0.007, respectively). The lymphocyte counts in the A, B, and C groups were ranked from high to low upon admission, and the differences among the three groups were statistically significant (P values were 0.020, <0.001 and 0.006 for the contrasts between groups A and B, groups A and C, groups B and C, respectively), the NLR were ranked from low to high, and the differences among the three groups were statistically significant (P values were 0.001, <0.001 and 0.026 for the contrasts between groups A and B, groups A and C, groups B and C, respectively). Before discharge or death, there was no significant difference in lymphocyte counts and NLR between A and B groups (P>0.05), and there were statistically significant differences between group C and groups A and B (all P values were<0.001). The proportions of “Neutrophils Lymphocytes Convergence” in groups A and B were 64.7% and 76.2%, respectively, which were significantly higher than that in group C (10.0%). The proportions of “Neutrophils Lymphocytes Separation” in group C was 70.0%, which was significantly higher than those in groups A (0) and B (4.8%). The area under the curve of NLR predicting patients with severe disease (excluding death) was 0.843, with the sensitivity and specificity of ≥3.55 be 0.810 and 0.882; The area under the curve of lymphocyte count predicting death in severe patients was 0.845, with the sensitivity and specificity be 0.700 and 0.905, respectively.ConclusionsDynamic changes in the composition of peripheral blood cells are one of the clinical features of COVID-19, “Neutrophils Lymphocytes Convergence” and “Neutrophils Lymphocytes Separation” predict better and worse clinical outcomes, respectively. NLR and lymphocyte counts are effective indicators for predicting the severity and death of COVID-19.
Objective To evaluate clinical outcomes of complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with peripheral lung cancer.?Methods?We retrospectively analyzed clinical data of 90 consecutive patients with peripheral lung cancer who underwent complete VATS lobectomy from July 2009 to December 2011 in Provincial Hospital Affiliated to Anhui Medical University. There were 55 male patients and 35 female patients with their age of 33-79 （62.5 ±11.5） years. Lymph node dissection group and number, operation time, intraoperative blood loss, length of postoperative chest drainage, length of postoperative hospitalization, postoperative morbidity and pain score were analyzed.?Results?There was no hospital death in this group. Operation time was 135.0±32.5 min, intraoperative blood loss was 230.0±80.4 ml, length of postoperative chest drainage was 4.8±2.1 days, and pain score on the third postoperative day was 5.3±1.2. A total of 520 groups and 1 568 lymph nodes were dissected during the operation, with 5.8 groups and 17.4 lymph nodes dissected in each patient. There were 71 groups with lymph node metastasis, a positive rate of 13.7% （71/520）. Postoperatively, 2 patients had hoarseness and 3 patients had chylothorax, who were all cured after proper treatment. Ninety patients were followed up for 1-24 months. During follow-up, 4 patients died of tumor metastasis, and other patients were all alive with good quality of life.?Conclusion?Complete VATS lobectomy is a minimally invasive technique for patients with peripheral lung cancer with better postoperative recovery and reduced pain level. The safety and degree of radical resection of complete VATS lobectomy is similar to those of routine thoracotomy lobectomy. Complete VATS lobectomy can be recommended as a surgical treatment for patients with peripheral lung cancer.
To ensure the scientific and recognized evaluation of patient-centered clinical research outcomes, the drug development tool qualification certification website of the Center for Drug Evaluation and Research and the Center for Biologics Evaluation and Research have disclosed the information of clinical outcome assessment (COA) submitted for certification, and encouraged the use of certified COA. This paper searched all COA and approval decisions on the website, analyzed the submitted information and certification status of COA, and interpreted the certification technology and process of COA, so as to provide references and suggestions for the development of patient-centered clinical research outcome evaluation.
In order to better incorporate patient input in clinical trials, the US Food and Drug Administration has included "patient-focused drug development" in the selection and development of clinical outcome assessments, and formulated a series of guidelines. Based on the third guiding principle, "Selecting, Developing, or Modifying Fit-for-Purpose Clinical Outcome Assessments", this article summarizes the clinical outcome assessments from five aspects: concept, development process, scoring mechanism, interference factors and sensitivity, and introduces four different types of clinical outcome assessments, providing new ideas for "patient-focused drug development" efficacy evaluation in clinical trials.
ObjectiveTo investigate surgical indications and techniques of video-assisted thoracoscopic surgery (VATS) for mediastinal lymph node tuberculosis. MethodsClinical data of 27 patients who underwent VATS for mediastinal lymph node tuberculosis between January 2010 and March 2013 in Wuhan Medical Treatment Center were retrospectively analyzed. There were 16 male and 11 female patients with their age of 18-67 (30.23±10.72) years. ResultsThere was no in-hospital death. Postoperative complications included recurrent laryngeal nerve injury in 1 patient, delayed wound healing in 1 patient and pneumothorax in 1 patient. Postoperatively, all the patients received intensified anti-tubercular treatment, and were engaged in normal physical activities during follow-up of 6 months. ConclusionVATS is safe and reliable for the treatment of mediastinal lymph node tuberculosis, and anti-tubercular treatment is needed before and after the operation.
ObjectiveTo evaluate the clinical therapeutic effect of support plates on Schatzker type Ⅳ tibial plateau fractures.MethodsPatients with Schatzker type Ⅳ tibial plateau fractures underwent support plates treatment between April 2013 and September 2014 by using the medial incision or posterior medial incision, if necessary, with other auxiliary incisions, with limited contact compression plate, 1/3 tubular plate or " T” plate to support the fracture. ResultsA total of 14 patients including 6 males and 8 females with an average age of (35.2±9.8) years (ranged from 20 to 52 years) were enrolled in this study and followed up for 12–25 months with an average of (16.3±4.0) months. The knee joints were flexed 80–130° with an average of (97.9±13.1)° one month after the surgery and 90–140° with an average of (119.3±12.1)° three months after the surgery. One year postoperatively, the mean Hospital of Special Surgery knee score ranged from 78 to 96 with an average of 88.4±4.9. Last follow-up assessment of knee function according to Rasmussen scoring system showed excellent in 8 cases, good in 4 cases, and fair in 2 cases; the excellent and good rate was 85.7%. No postoperative complications such as infection, nonunion, vascular nerve injury, or internal fixation failure occurred. ConclusionThe support plates for the treatment of Schatzker type Ⅳ tibial plateau fractures can maintain good reduction, prevent the secondary collapse of the tibial plateau, ensure that knee joint has good alignment, less complications with vascular or nerve injuries, and finally get a satisfied function recovery.
ObjectiveTo compare extra-articular and intra-articular olecranon osteotomy in treating intercondylar fractures of the distal humerus managed with open reduction and internal fixation regarding the functional outcomes and complications. MethodsBetween September 2008 and December 2010, 36 patients with intercondylar fractures of the distal humerus were treated by open reduction and internal fixation using the trans-olecranon approach. Among the, 21 underwent extra-articular olecranon osteotomy and 15 accepted intra-articular olecranon osteotomy. The mean follow-up time was three years. We compared the elbow function, the rate of no non-union or delayed union and the rate of postoperative complications between the two groups. ResultsThe elbow function and Mayo elbow performance scores were good at the latest follow-up. There was no non-union in all osteotomies. We found significant difference in delayed union (P=0.01) and traumatic arthritis rate (P=0.02) between the two groups. ConclusionExtra-articular olecranon osteotomy is better for bone union and the decrease of traumatic arthritis rate.
ObjectiveTo analyze the outcome and prognostic factors of using locking plate for treating proximal humerus fracture. MethodsBetween January 2005 and January 2012, 45 aged patients with a displaced 3-part or 4-part fracture of the proximal humerus were treated by locking plate. Range of motion and Constant-Mudey score were observed during the follow-up. ResultsForty-three patients were followed up from 12 to 48 months with an average of 18 months. The mean final Constant-Mudey score was 72.3±9.5 and 6 of them needed a second surgery. In addition to fracture type, other prognostic factors included redisplacement (4 cases, 9.3%), nonunion (3 cases, 7.0%), crashing (3 cases, 7.0%), necrosis of the humeral head (6 cases, 14.0%) and screw cut-out (5 cases, 11.6%). Among the patients with disrupted medial calcar, 4 needed a second surgery at the final follow-up, 3 had redisplacement, 2 had nonunion, and 2 had screw cut-out. ConclusionLocked screw-plates provide more secure fixation of fracture in aged patients, but the complication rate remains high. We suggest anatomic reduction, and plate and screws position, length of the screws, the medial cortical contact and stability may be the chief prognostic factors affecting the shoulder function following a proximal humeral fracture.
ObjectiveTo evaluate the impact of using alanyl-glutamine dipeptide on clinical outcome for gastric cancer patients with nutritional risk after total gastrectomy. MethodsThis study was carried out in the period from March to August 2015. The nutritional risk was screened by continuous sampling method in the new hospitalized patients with gastric cancer who would undergo total gastrectomy. The patients were grouped randomly. Alanyl-glutamine was given to the experimental group patients. The clinical data of the two groups were analyzed, such as the laboratory parame-ters of nutritional status and hepatorenal function, complications of surgery, the nutrition-related hospitalization day, etc. ResultsThe preoperative data were consistent in the two groups of the included 40 cases. The results showed, in the third and seventh days after surgery, the level of plasma albumin was higher in the experimental group than in the control group〔(33.9±5.6) g/L vs. (30.8±4.0) g/L and (36.6±3.9) g/L vs. (33.9±4.2) g/L, respectively). Also, the CD4+/CD8+ cells immune index was significantly improved in the experimental group after surgery (1.7±0.7 vs. 1.2±0.3, P < 0.05). The recovery time of intestinal function〔(65.7±5.3) h vs. (71.6±7.2)h, P < 0.01)〕and nutrition-related hospitalization day〔(10.1±1.8) d vs. (11.7±1.9)d, P < 0.01)〕in alanyl-glutamine dipeptide group were shorted than that in the control group. No serious adverse drug reactions were found in the patients during the treatment period. ConclusionApplication alanyl-glutamine to the patients with nutritional risk after total gastrectomy could partly improve clinical outcome indicators.