ObjectiveTo systematically review the efficacy and safety of nickel-titanium shape memory alloy compression anastomosis clip (Ni-Ti CAC) for gastrointestinal anastomosis. MethodsThe Cochrane Library, PubMed, Web of Knowledge and CBM databases were searched for the randomized controlled trials (RCTs) that investigated the efficacy and safety of Ni-Ti CAC versus surgical stapler for gastrointestinal anastomosis. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.2. ResultsEight RCTs involving 457 patients were included in the meta-analysis. The results of meta-analysis showed that, compared with the surgical stapler group, the Ni-Ti CAC group was superior in operation time (MD=-8.30, 95%CI-15.58 to-1.02, P=0.03), food intake (MD=-0.37, 95%CI-0.70 to-0.03, P=0.03), bowel movement (MD=-1.13, 95%CI-1.67 to-0.59, P < 0.000 1), passing gas time (MD=-0.30, 95%CI-0.55 to-0.06, P=0.01), and length of hospital stay (MD=-1.04, 95%CI-1.35 to-0.74, P < 0.000 01), with significant differences. No significant difference was found in anastomosis time (MD=-1.84, 95%CI-3.91 to 0.22, P=0.08). As for safety, no significant difference was found in anastomosis-related complications between both groups. ConclusionCurrent evidence shows that Ni-Ti CAC achieves better efficacy and safety in gastrointestinal anastomosis compared with surgical stapler.
ObjectiveTo evaluate the accuracy of the new dynamic approach in the measurement of respiratory mechanics with different pressure support (PS) level during pressure support ventilation (PSV) via oral-nasal mask.MethodsThe Respironics V60 ventilator was connected to a ASL5000 lung simulator, which simulate lung mechanics in patients with chronic obstructive pulmonary disease ［system compliance (Crs)=50 mL/cm H2O, airway resistance (Raw)=20 cm H2O/(L·s), inspiratory time (TI)=1.6 s, breathing rate=15 beats per minute］. PSV were applied with different levels of PS ［positive end-expiratory pressure=5 cm H2O, PS=5/10/15/20/25 cm H2O) and back-up rate=10 beats per minute］. Measurements were conducted at system leaks with 25 – 28 L/min. The performance characteristics and patient-ventilator asynchrony were assessed, including flow, airway pressure, time and workload. Crs and Raw were calculated by using new dynamic approach.ResultsTidal volume (VT) was increased with increasing PS level ［(281.45±4.26)mL at PS 5 cm H2O vs. (456.81±1.91)mL at PS 10 cm H2O vs. (747.45±3.22)mL at PS 20 cm H2O, P<0.01］. Severe asynchronous was occurred frequently when PS is at 25 cm H2O. Inspiration cycling criterion (CC) was up-regulated accompanied by increasing PS level ［(15.62±3.11)% at 5 cm H2O, vs. (24.50±0.77)% at 20 cm H2O, P<0.01］. Premature cycling was always existed during PSV when PS < 20 cm H2O, which could be eliminated as PS level increasing. Delay cycling was found when PS was at 20 cm H2O, and cycling delay time was (33.60±15.91)ms (P<0.01). The measurement of Crs was (46.19±1.57)mL/cm H2O with PS at 10 cm H2O, which was closer to the preset values of simulated lung. The underestimate of Crs was observed during high level PS support. The calculation of inspiratory and expiratory resistance was approximate to 20 cm H2O/(L·s) when PS level was exceeded 15 cm H2O.ConclusionsThe new dynamic approach can continuously assess the respiratory mechanics during non-invasive ventilation, which is no need to interrupt the patient's spontaneous breathing. Higher inspiratory flow during PSV is beneficial for Raw measurement, whereas the accuracy of Crs was influenced by the value of actual VT.
Medical device-related pressure injury (MDRPI) is a kind of pressure injury that occurs in the course of diagnosis and treatment, and its appearance is similar to that of medical device. Neonatal intensive care unit (NICU) infants are more likely to develop MDRPI than children and adults because of the physiological characteristics of skin and the influence of disease. At present, the occurrence of MDRPI in NICU infants is attracting worldwide attention. Its treatment and nursing consume a large amount of medical resources, which not only affect the outcome of the disease, but also increase the economic burden of the family and society. This article summarizes the MDRPI from three aspects: summary, influencing factors, and evaluation tools. It is expected that NICU nurses will carry out large sample clinical investigation of MDRPI in the future, so as to provide a reference for risk prediction model and risk assessment tools to identify high-risk infants and take effective measures in advance to reduce the incidence of MDRPI.
Objective?To observe the changes of force bearing area and pressures of the rabbit tibiofemoral contact area and the biomechanical reconstruction level of joint after meniscal allograft.?Methods?A total of 28 Japanese rabbits were involved, weighing 3.0-3.5 kg, male or female. Of 28 rabbits, 7 were selected as meniscus donors, the remaining 21 rabbits were randomized into group A (n=7), group B (n=7), and group C (n=7). Group A underwent single knee opening and suturing, group B underwent medial meniscus excision and suturing, and group C underwent medial meniscus allograft after medial meniscus excision and suturing. The rabbits were sacrified at 12 weeks after operation for biomechanical observation through biomechanical machine and color imaging system. The meniscus tissue specimens were harvested from groups A and C to perform histological and immunohistochemical staining.?Results?After operation, all rabbits in 3 groups survived to the end of experiment. There were significant differences in the force bearing area and pressures at 0-90° flexion between group B and groups A, C (P lt; 0.05) at 12 weeks, showing no significant difference between group A and group C (P gt; 0.05); and there were significant differences in the force bearing area and pressures at 120° flexion among 3 groups (P lt; 0.05). The histological observation showed that the number of cartilage cells and collagen fibers returned to normal in group C, and the immunohistochemical staining showed that transplanted meniscus of group C contained large amounts of collagen fibers consisting of collagen type I and collagen type II. After 12 weeks of operation, the collagen type I contents were 0.612 5 ± 0.059 8 in group A and 0.587 2 ± 0.063 9 in group C, showing no significant difference (t=0.765, P=0.465); the collagen type II contents were 0.772 4 ± 0.081 5 and 0.814 3 ± 0.051 7, respectively, showing no significant difference (t= —0.136, P=0.894).?Conclusion?The allograft of rabbit meniscus can significantly increase the force bearing area of the tibiofemoral contact area and reduce the average pressure. Therefore, biomechanically speaking, the meniscus allograft can protect the articular cartilage and reconstruct the biomechanical balance.
Objective To explore the influence of discectomy and artificial disc replacement on the upper lumbar facet joint and to provide the evidence for use of artificial disc replacement. Methods Under the loads of 200-2 000 N axis pressure and 1-10 Nm back-extending/side-bending pressure on the 7 fresh adult corpses, the pressure of L3,4facet joint was measured in the case of L4,5disc integrity, discectomy and artificial disc replacement and the statistical analysis was done.ResultsUnder the same load (axis, back-extending/side bending), there were significant differences (Plt;0.01) in the pressure of upper lumbar facet jointboth between disc integrity and discectomy and between discectomy and artificial disc replacement, and there was no difference(Pgt;0.05) between disc integrity and artificial disc replacement. Conclusion The stress ofupper lumbar facet joint reduced after discectomy, it implies that simply discectomy may change biomechanics of lumbar and lead to secondary lumbar structure degeneration. The stress of upper lumbar facet joint is close to the normal value after artificial disc replancement, it implies that artificial disc replacement may protect lumbar structure. It provides some biomechanics foundation and evidence for artificial disc replacement.
Objective To explore the effects of changes in the length of the patella on patellofemoral contact areas and pressures, to provide a theoretical foundation for treatment of lower pole of patella fracture. Methods Using homemadeloadingequipment, pressure sensitive films of 100 mm × 100 mm in size were placed on the force platform, vertically downwardload (0-19.6 N) was given. The pressure-sensitive response curve was obtained by computer image analysis of the pressuresensitive tablets and calculation. Six male left fresh knee specimens from voluntary donation were placed in homemade-test fixed load device, and the double-layer pressure sensitive film was placed on the patellofemoral joint surface; under loading of 196 N at flexion of 0, 15, 30, 45, 60, 75, 90, 105, 120, and 135° for 2 minutes, respectively, the pressure sensitive film was removed as the control group. Patellas were transected cut and in situ fixed by Kirschner wire and steel-wire as in situ fixation group. Bone fragments obtained from the corresponding 1/6 and 2/6 of contralateral patella, were embedded in the interspace between osteotomy with internal fixation with Kirschner wire and steel-wire respectively as lengthening group. Followed by the amputating patella length of 1/6, 2/6, 3/6 from proximal to distal and internal fixation with Kirschner wire and steel wire by turns as a shortening group. Repeat the above steps of each experiment. By image analysis the pressure sensitive film, the patella joint contact area were measured, and patellar contact pressure (including the peak pressure and average pressure) was calculated according to pressure-sensitive response curve. Results The actural contact area were significantly smaller in the shortening groups than in the control group at flexion of 30-135° (P lt; 0.05); the pressure was significantly bigger in shortening 1/6 group at flexion of 0, 15, 60, and 75°, in shortening 2/6 group at flexion of 0° and 75-135°, and in shortening 3/6 group at flexion of 0-30°and 75-135° than in the control group (P lt; 0.05); the peak pressure was significantly bigger in shortening 1/6 group at flexion of0, 15, and 60-105°, in shortening 2/6 group at flexion of 0, 15, and 75-105°, and in shortening 3/6 group at flexion of 0, 30, and 60-135° than in the control group (P lt; 0.05). The actural contact area was significantly smaller in the lengthening groups than in the control group at flexion of 15, 60, and 90°, and it was bigger at flexion of 105, 135° in lengthening 2/6 group than in the control group (P lt; 0.05); the pressure was significantly bigger in the lengthening groups at flexion of 15-75° than in the control group and it was smaller in the lengthening groups at flexion of 105, 135°, and smaller in lengthening 2/6 group at flexion of 120° (P lt; 0.05); the peak pressure was significantly smaller in lengthening 1/6 group than in the control group at flexion of 0, 90, and 105° and smaller in lengthening 2/6 group at flexion of 0° (P lt; 0.05). The actural contact area was significantly bigger in all lengthening groups than in all shortening groups at flexion of 30, 45, and 75-135° (P lt; 0.05). The pressure was significantly bigger in shortening 1/6 group than in lengthening groups at flexion of 0, 60, and 90° (P lt; 0.05), in shortening 2/6 group at flexion of 0, 60, and 90-120° (P lt; 0.05), in shortening 3/6 group at flexion of 0-135° (P lt; 0.05). The peak pressure was bigger in shortening groups than in lengthening 1/6 group at flexion of 0, 90, and 105° (P lt; 0.05), bigger than lengthening 2/6 group at flexion of 0° (P lt;0.05余請見正文.....
Objective To formulate an evidence-based adjuvant therapeutic plan for a patient with large area pressure ulcers. Methods Based on an adequate assessment of the patient’s condition and using the principle of PICO, we searched The Cochrane Library (Issue 1, 2008), DARE (Issue 3, 2008), CCRT (Issue 1, 2008), MEDLINE (1980~ March 2008) and Chinese Journal Full-text Database CNKI (1979~2008) for the best available clinical evidence on adjuvant therapy of large area pressure ulcers with infrared rays, nutrition support and some special overlays. Results Two systematic reviews and three randomized controlled trials were included. According to the current evidence, as well as the patient’s clinical condition and preference, a comprehensive therapeutic plan was given to the patient. And in the next three months with the therapeutic plan, the patient’s large area pressure ulcers had already recovered. Conclusion Evidence based approaches can help us develop the best comprehensive therapeutic plan for the patient and will help improve the therapeutic results for patients with large area pressure ulcers.
ObjectiveTo investigate the operation and effect of pressure ulcers group (PUG) on the procedure of clinical management of pressure ulcers. MethodsThe in-hospital patients with high-risk pressure ulcers and patients with pressure ulcers from outside of the hospital (n=145) before the founding of PUG in 2011 were regarded as group A, and patients in this group were treated by traditional therapies. After PUG was founded in our hospital in January 2012, 192 patients with high-risk pressure ulcers and from outside of the hospital in 2012 were considered as group B. In addition, group C contained 380 patients treated in 2013. Group B and C were both treated by PUG that developed a management system of pressure ulcers and took active measures to control and prevent pressure ulcers. PUG trained 30 clinical nurse supervisors, who were recommended from relevant clinical departments. The incidence of inevitable pressure ulcer of hospitalized patients, the cure rate of patients with pressure ulcers from outside of the hospital, pressure ulcer knowledge level of clinical nurse supervisors were comparatively analyzed between group A and B, and between group A and C, respectively. ResultsAfter the establishment of PUG, the incidence of inevitable pressure ulcer of hospitalized patients in group A, B, and C was 76.20%, 17.02%, and 14.61%, respectively. The cure rate of patients from outside of the hospital was 54.84%, 86.84%, and 87.97%, respectively. Differences between group A and B, and between group A and C both were significant (P<0.01). The pressure ulcer knowledge level of all nurse supervisors improved significantly (P<0.001). ConclusionThe establishment of PUG makes the clinical pressure ulcer management more scientific and objective. Furthermore, it can effectively reduce the incidence of pressure ulcers, and also improve the quality of medical care and ensure the safety of patients.
Simulation of the human biological lung is a crucial method for medical professionals to learn and practice the use of new pulmonary interventional diagnostic and therapeutic devices. The study on ventilation effects of the simulation under positive pressure ventilation mode provide valuable guidance for clinical ventilation treatment. This study focused on establishing an electrical simulation ventilation model, which aims to address the complexities in parameter configuration and slow display of air pressure and airflow waveforms in simulating the human biological lung under positive pressure ventilation mode. A simulated ventilation experiment was conducted under pressure-regulated volume control (PRVC) positive pressure ventilation mode, and the resulting ventilation waveform was compared with that of normal adults. The experimental findings indicated that the average error of the main reference index moisture value was 9.8% under PRVC positive pressure ventilation mode, effectively simulating the ventilatory effect observed in normal adults. So the established electrical simulation ventilation model is feasible, and provides a foundation for further research on the simulation of human biological lung positive pressure ventilation experimental platform.
Objective To investigate the current status of randomized controlled trials (RCTs) and clinical controlled trials (CCTs) on pressure sore in China. Methods We searched Chinese Journal of Nursing, Chinese Journal of Practical Nursing and Journal of Nurses Training in CNKI and VIP (January 2000 to December 2005) for Chinese articles on pressure sore, using "pressure sore", "bed sore", "nursing", "treatment", "prevention", "evaluation" and "management" as search terms. The retrieved articles were summarized. Results We identified 16 reports (10 RCTs and 6 CCTs). The studies were judged to be of low quality.There was one study on the evaluation, two on the prevention, and 13 on the treatment of pressure sores. Conclusion The current studies on pressure sore in China are focusing on treatment. Randomized controlled trials of large sample size of pressure sore are needed to improve nursing quality.