Medicine
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Insertion of a fully covered self-expandable metallic stent (FCEM) through endoscopic retrograde cholangiopancreatography is an effective solution for biliary anastomotic stricture following orthotopic liver transplantation (OLT). However, FCEM migration continues to plague patients. This study aimed to evaluate the FCEM migration rate in our center, and to investigate the factors increasing the migration risk for FCEM. ⋯ The serum AST level was significantly higher in the migration group than that in the nonmigration group (52.48 vs 29.50 U/L, P < .05). A lower serum AST level was associated with a decreased risk of FCEM migration in post-OLT patients with duct-to-duct anastomotic stricture (hazard ratio = 0.968, 95% confidence interval: 0.940-0.996, P = .028). In this single-center, retrospective cohort study, we showed that an elevated serum AST level was a potential risk factor for FCEM migration.
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We researched on the factors affecting the duration of antibiotic use due to surgical site inflammation after complication-free classical total knee arthroplasty (TKA). Four hundred and eighty-nine cases who underwent primary TKA performed by 1 surgeon from January 2015 to December 2018 were enrolled. Including the day of operation, first-generation cephalosporin was injected intravenously for 3 days for antimicrobial prophylaxis. ⋯ In univariate analysis, total operative time and transfusion were factors affecting the duration of antibiotic use due to surgical site inflammation (<6 days or ≥6 days). Multivariate analysis of age, gender, body mass index, staged bilateral TKA, diabetes mellitus, preoperative glomerulus filtration rate, preoperative albumin level, prior history of anticoagulant usage, allogenic blood transfusion during admission, and total operative time revealed that longer operative time was related to higher likelihood of antibiotic use for >6 days during admission. When prophylactic antibiotics are prescribed, surgeons must note that signs of superficial incisional surgical site inflammation after classical complication free TKA may manifest more often in patients with longer operative time.
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Primary pulmonary lymphoma (PPL) is a rare disease, and rapid progression of pulmonary exudation leads to severe respiratory failure. Here, we present the case of a critically ill patient with PPL complicated by refractory hypoxemic respiratory failure. The patient was ultimately cured with a successful combination of extracorporeal membrane oxygenation (ECMO) and chemotherapy. ⋯ ECMO can be selected as an important salvage treatment for patients with severe cardiopulmonary dysfunction caused by PPL and other malignant tumors that may be cured or transferred to a stable stage.
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The differences between the pathologies of cases of type A acute aortic dissection (AAD) that did and did not result in prehospital death (PHD) have not been fully elucidated. This study aimed to compare the CT findings and clarify the differences between the pathologies of such cases. Ninety four consecutive type A AAD patients between 2010 and 2020 were enrolled in this study. ⋯ Most PHD due to type A AAD are associated with hemorrhaging. Bleeding into the pericardium and type A AAD confined to the thoracic aorta are significant risk factors for PHD. Secondary respiratory failure might contribute to PHD in such cases.
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Autoimmune hemolytic anemia (AIHA) therapy may be associated with severe complications such as diabetes, hypertension, obesity, osteoporosis, peptic ulcers, infection, and some other diseases. To reduce those effects, we used low-dose rituximab, bortezomib and dexamethasone (LowR-BD regimen) to treat AIHA. The purpose of this study was to evaluate the efficacy and safety of this regimen. ⋯ One patient relapsed and achieved PR after retreatment of 2 cycles LowR-BD regimen. The patients tolerated the treatment well and did not complain of apparently adverse reactions except a patient with Sjogren's syndrome and bronchiectasis who developed a severe infection during treatment. Low-dose rituximab combined with bortezomib and dexamethasone is effective and relatively safe in patients with wAIHA.