Medicine
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Extralevator abdominoperineal excision (ELAPE) may cause various surgical complications including disruption of perineal wound, perineal hernia and adhesive small-bowel obstruction. Pelvic peritoneum reconstruction (PPR) could prevent those complications, but it may not always be achievable, especially in patients with severe pelvic fibrosis after neoadjuvant radiotherapy. Our previous study has reported the application of the PPR using the bladder peritoneum flap in laparoscopic ELAPE. The aim of the study is to evaluate the short-term clinical, technical and safety outcomes of PPR using the bladder peritoneum flap in laparoscopic ELAPE. ⋯ This experiment was approved by the Biomedical Ethics Committee of West China Hospital of Sichuan University.
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Clinical Trial
Integrated analysis identifies an immune-based prognostic signature for the mesenchymal identity in colorectal cancer.
Colorectal cancer (CRC) has been divided into 4 consensus molecular subtypes (CMSs), of which CMS4 has the mesenchymal identity and the highest relapse rate. Our goal is to develop a prognostic signature by integrating the immune system and mesenchymal modalities involved in CMS4. ⋯ We propose an immune-based signature identified by network analysis, which is a promising prognostic biomarker and help for the selection of CRC patients who might benefit from more rigorous therapies. Further prospective studies are warranted to test and validate its efficiency for clinical application.
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The utilization of elastic stable intramedullary nail (ESIN) in length unstable femoral shaft fractures in children remains controversial, and the results in different studies vary a lot. This study aims to investigate the clinical outcomes of ESINs versus submuscular plate (SMP) in length unstable femoral shaft fractures. Patients aged 5 to 11 years old with length unstable femoral shaft fractures treated at our institute from January 2008 to January 2018 were included and categorized into ESIN and SMP group. ⋯ Both ESIN and SMP are safe and effective choices for length unstable femoral shaft fractures in children aged 5 to 11 years. In ESIN, extra care is required to provide additional immobilization using spica cast or brace. Compared with SMP, ESIN is able to deliver comparable clinical outcomes with less EBL, operative time and shorter hospital stay.
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Vital signs (VS) are dynamic parameters and understanding the significance of changes in VS in the acute setting may offer clinical meaning. We aimed to measure dynamic changes in vital signs (ΔVS) between site of trauma and presentation to hospital and investigate the association between ΔVS and in-hospital mortality among elderly with trauma. We conducted a retrospective cohort study between 2004 and 2015 using data from the nationwide trauma registry. ⋯ Overall in-hospital mortality rate was 10.0%. In-hospital mortality increased from 9.0% to 16.5% for -ΔSBP; 9.2% to 22.2% for ΔHR; and 9.7% to 15.9% for ΔRR. ΔVS scores of 0, 1, 2, and 3 points were associated with in-hospital mortality of 8.2%, 14.9%, 30.1%, and 50.0%, respectively. A score based on the dynamic changes of VS, ΔVS score, may be helpful in predicting in-hospital mortality among elderly with trauma.
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Case Reports
Warfarin-induced impairment of bone material quality in a patient undergoing maintenance hemodialysis: A case report.
The use of warfarin in patients undergoing hemodialysis is associated with decreased bone mineral density and an increased incidence of bone fracture. However, no studies to date have directly estimated bone quality with bone histomorphometry in patients with bone abnormalities who are taking warfarin and undergoing hemodialysis. ⋯ Warfarin can induce impairment of bone material quality in a patient undergoing hemodialysis.