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简介：AbstractBackground:We sought to explore an optimal clinical nursing mode following a hybrid surgery for cerebral arteriovenous malformation.Methods:Patients with complex cerebral arteriovenous malformations seen in our neurosurgery department from January 2016 to December 2017 were prospectively enrolled. The hybrid surgery protocol included "angiographic diagnosis, surgical resection, and intraoperative angiographic evaluation" and "angiographic diagnosis and embolization, surgical resection, and intraoperative angiographic evaluation" . The patients were randomly stratified into intensive care group and routine care group. After surgery, intensive or routine care was provided, and the prognosis of patients was evaluated, with a subsequent comparative analysis.Results:A total of 109 cases were divided into the routine nursing group (n = 54 cases) and intensive nursing group (n = 55 cases). There were no significant differences between the two groups in baseline data before surgery. Postoperative lung infection in the intensive nursing group was significantly less frequent than those in the routine nursing group (5.5% vs. 18.5%, P=0.039) with pulmonary infection and lower extremity venous thrombosis (5.5% vs. 24.1%, P=0.006). The average hospital stay in the intensive nursing group was 14.4 ± 5.78 days, which was significantly lower than that in the routine nursing group (19.3 ± 6.38 days, P=0.013). At 3 months’ follow-up after surgery, the Generic Quality of Life Inventory-74 (GQOLI-74) dimension score and GQOLI-74 total score in the enhanced group were significantly better than those in the routine nursing group (P=0.017 and 0.023, respectively).Conclusions:Intensive postoperative nursing can improve the safety of patients after hybrid surgery, reduce the postoperative complications and the average length of hospital stay, and improve the quality of life of patients.

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简介：AbstractBackground:Geriatric hip fracture patients receiving clopidogrel are a surgical challenge. In China, most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days. However, delayed surgery is associated with increased complications and mortality in the older adults. This retrospective paralleled comparison study investigated the safety of early surgery for geriatric hip fracture patients within 5 days of clopidogrel withdrawal.Methods:Acute hip fracture patients (≥65 years) who were hospitalized in the orthogeriatric co-management ward of Beijing Jishuitan Hospital between November 2016 and April 2018 were retrospectively reviewed. Sixty patients taking clopidogrel before injury and discontinued <5 days before surgery constituted the clopidogrel group. The control group constituted 60 patients not taking antiplatelet or anticoagulant drugs and matched 1:1 with the clopidogrel group for sex, fracture type, operative procedure, and time from injury to operation (±10 h). The primary outcome was perioperative blood loss and the secondary outcomes were transfusion requirement, complications, and mortality. The Student’s t test or Wilcoxon signed rank sum test was used for continuous variables and the Chi-square test was used for categorical variables.Results:Age, body mass index, American Society of Anesthesiologists score, and percentage undergoing general anesthesia were comparable between the groups (P > 0.050). The percentages of patients with coronary heart disease (61.7% vs. 18.3%; P < 0.001) and cerebrovascular disease (45.0% vs. 15.0%; P < 0.010) were significantly higher in the clopidogrel vs. control groups, respectively. The median clopidogrel discontinuation time before operation was 73.0 (range: 3.0-120.0) h. There was no significant difference in the estimated perioperative blood loss between the clopidogrel group (median: 745 mL) and control group (median: 772 mL) (P = 0.866). The intra-operative transfusion rate was higher in the clopidogrel group (22/60, 36.7%) than that in the control group (12/60, 20.0%) (P < 0.050). However, there was no significant difference in the blood transfusion rate during the entire perioperative period (26/60, 43.3% vs. 20/60, 33.3%; clopidogrel group vs. control group, respectively; P > 0.050). There was no significant difference in perioperative complications, and 30-day and 1-year mortality rates between the groups.Conclusions:Early hip fracture surgery is safe for elderly patients within 5 days of clopidogrel withdrawal, without increased perioperative blood loss, transfusion requirement, complications, and mortality compared with patients not taking antiplatelet drugs.

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简介：AbstractBackground:Early microsurgical clipping is recommended for ruptured intracranial aneurysms to prevent rebleeding. However, dilemma frequently occurs when managing patients with current acetylsalicylic acid (aspirin) use. This study aimed to examine whether aspirin use was associated with worse outcomes after early surgery for aneurysmal subarachnoid hemorrhage (aSAH).Methods:We retrieved a consecutive series of 215 patients undergoing early microsurgical clipping within 72 h after aneurysmal rupture from 2012 to 2018 in the neurosurgery department of Beijing Tiantan Hospital. The medical records of each case were reviewed. Twenty-one patients had a history of long-term aspirin use before the onset of aSAH, and 194 patients did not. To reduce confounding bias, propensity score matching (PSM) was performed to balance some characteristics of the two groups. The intraoperative blood loss, postoperative hemorrhagic events, postoperative hospital stay, and functional outcome at discharge were compared between aspirin and non-aspirin group.Results:We matched all the 21 patients in aspirin group with 42 patients in non-aspirin group (1:2). Potential confounding factors were corrected between the two groups by PSM. No hospital mortality occurred after surgery. No significant differences were found in intraoperative blood loss (P = 0.540), postoperative hemorrhagic events (P > 0.999), postoperative hospital stay (P = 0.715), as well as functional outcome at discharge (P = 0.332) between the two groups.Conclusions:Our preliminary results showed that long-term low-dose aspirin use was not associated with worse outcomes. Early surgery can be safe for ruptured intracranial aneurysms in patients with long-term aspirin use.

简介：AIMTo比较fluorometholone的联合0.1%并且0.5%在控制发炎并且与intraocular透镜implantation.METHODSSixty在phacoemulsification以后阻止感染掉到tobramycin/dexamethasone眼睛的levofloxacin从60看经历奔流phacoemulsification的病人被使随机化进二个组；病人的一半与与levofloxacin(4times/d)相结合的fluorometholone(6times/d)被对待，当另外的一半与眼睛掉一个星期的tobramycin/dexamethasone(4times/d)被对待时。在操作和1wk追随者treatments.RESULTSThere不是在角膜的厚度(P0.629)的二个组之间的统计上重要的差别以前，外科手术前、手术后的intraocular压力，水的闪光，角膜的厚度，和症状被记录，水的闪光(P0.398)，并且症状分数(P0.350)在每次指。眼睛的高血压仅仅在与levofloxacin治疗表演相结合的tobramycin/dexamethasonegroup.CONCLUSIONFluorometholone在二只眼睛被观察可比较的功效但是没有增加intraocular压力的趋势；因此，它可能是为手术后的使用的更好的政体。

简介：Objective:Thisworkaimedtostudythesafetyandefficacyofpreoperativeintestinalstentdecompressioncombinedwithlaparoscopicsurgerytotreatleft-sidedcolorectalcancerwithobstruction(LCCO).Methods:Retrospectiveanalysiswasconductedondataobtainedfrom21LCCOpatientsadmittedtoTheFirstAffiliatedHospitalofZhejiangChineseMedicineUniversityduringMarch2008andDecember2011.Toremovetheintestinalobstruction,preoperativeintestinalstentplacementundercolonoscopicguidancewasperformed.Approximately7to10daysaftertheoperation,laparoscopicradicalsurgeryofcolorectalcancerwasconducted.Results:Amongthe21casesstudied,laparoscopicsurgerywassuccessfulin20patients.Emergentlaparotomywasconductedinonepatientbecauseoftumorinvasionintheureter.Thedurationoftheoperationrangedfrom180to320min,andtheaveragetimewas220min.Therecoverytimeforbowelfunctionrangedfrom2to5dayswithanaveragetimeof3days.Postoperativeinfectionoftheincisionoccurredinonecase.Noanastomoticleakagewasobservedinanyofthecases.Conclusion:Preoperativeintestinalstentdecompression,combinedwithprimarystagelaparoscopicsurgery,isasafeandeffectivemethodforthetreatmentofLCCO.

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