Effect of Uterine Arterial Chemoembolization Combined with Ultrasound-Guided Uterine Curettage on Cervical Pregnancy and Influencing Factors

This is a retrospective study to analyze the efficacy of uterine artery chemoembolization (UACE) combined with ultrasound-guided curettage in the treatment of cervical pregnancy and the factors affecting the postoperative outcome. A total of 26 subjects were included in the study and were divided into a control group of 12 and an observer group of 14, all patients with cervical pregnancy diagnosed in our hospital from January 2016 to January 2020. Patients in the control group were treated with methotrexate injection (MTX) combined with ultrasound-guided curettage in our hospital, while the observer group was treated with UACE combined with ultrasound-guided curettage. The efficacy of the two groups was evaluated at 3 months postoperatively, and data on patients’ age, days of menopause, pregnancy frequency, and vaginal bleeding were collected retrospectively. Intraoperative bleeding, time to recovery of serum human chorionic gonadotropin (HCG), hospitalization time, time to return to normal menstruation, time to disappearance of gestational sac, pregnancy frequency, presence of endometrial inflammation, gestational week, maximum diameter of gestational sac, thinnest myometrium, endogenous-exogenous type, gestational sac size, and HCG level were recorded in both groups. Single-factor analysis and multifactor logistic regression models were used to analyze the factors influencing the surgical outcomes of patients. The results of the study showed that the overall efficiency of the observer group was significantly higher than that of the control group, while intraoperative bleeding, hospital stay, time to return to normal menstruation, and time to disappearance of the gestational sac were all lower than those of the control group ( p < 0.05 ). The results of univariate and multifactorial analyses showed that endometrial inflammation, gestational week, maximum diameter of the gestational sac, thinnest myometrium, and endogenous-exogenous type could affect the patients’ postoperative recovery ( p < 0.05 ); gestational week, maximum diameter of the gestational sac, and thinnest myometrium were independent factors affecting the patients’ postoperative recovery ( p < 0.05 ). The above results suggest that UACE combined with ultrasound-guided uterine clearance for cervical pregnancy can significantly improve treatment efficacy, reduce intraoperative bleeding, and improve recovery time from postoperative related symptoms. The treatment efficacy of patients with cervical pregnancy was related to the gestational week, the maximum diameter of the gestational sac, and the thinnest muscle layer.

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Clinical effect of application of nursing concept of rehabilitation surgery for improvement of quality of postoperative recovery in orthopedics

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02610-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Hong Lv ◽

Ning Yang

Keyword(s):

Tract Infection ◽

Perioperative Period ◽

Postoperative Recovery ◽

Control Group ◽

Observation Group ◽

Activity Time ◽

Joint Function ◽

Vein Thrombosis ◽

Accelerated Rehabilitation

Abstract Objective To analyze the application of concept nursing of accelerated rehabilitation surgery in orthopedic postoperative recovery. Methods A total of 120 patients who received orthopedic surgery were divided into the control group undergoing routine orthopedic nursing and the observation group undergoing the concept of accelerated rehabilitation surgery nursing. Results Patients in the observation group had shorter in-bed activity time and out-of-bed activity time, average time of hospital stay, and lower total treatment costs. The incidence of incision infection, respiratory system infection, digestive tract infection, urinary tract infection, deep vein thrombosis, and other complications in the observation group was much lower. The recovery scores of joint function in the observation group at 1, 3, 6, and 12 months after the operation were all better, and the recovery rate of joint function within 1 year after the operation was higher. Conclusion Following the concept of accelerated rehabilitation surgery nursing during the perioperative period can improve the quality of postoperative orthopedic recovery.

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Placenta previa with posterior extrauterine adhesion: clinical features and management practice

BMC Surgery ◽

10.1186/s12893-020-01027-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yoshikazu Nagase ◽

Shinya Matsuzaki ◽

Masayuki Endo ◽

Takeya Hara ◽

Aiko Okada ◽

...

Keyword(s):

Propensity Score ◽

Blood Loss ◽

Cesarean Delivery ◽

Clinical Features ◽

Surgical Outcomes ◽

Multivariate Regression ◽

Placenta Previa ◽

Control Group ◽

Intraoperative Blood Loss ◽

Intraoperative Bleeding

Abstract Background A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. Methods This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. Results The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). Conclusions PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.

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Transversus abdominis Plane Block for Improved Early Postoperative Pain Management after Periacetabular Osteotomy: A Randomized Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm10030394 ◽

2021 ◽

Vol 10 (3) ◽

pp. 394

Author(s):

Jannis Löchel ◽

Viktor Janz ◽

Vincent Justus Leopold ◽

Michael Krämer ◽

Georgi I. Wassilew

Keyword(s):

Postoperative Pain ◽

Periacetabular Osteotomy ◽

Opioid Consumption ◽

Transversus Abdominis ◽

Control Group ◽

Block Group ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Ultrasound Guided ◽

Pain Scores

Background: Patients undergoing periacetabular osteotomy (PAO) may experience significant postoperative pain due to the extensive approach and multiple osteotomies. The aim of this study was to assess the efficacy of the transversus abdominis plane (TAP) block on reducing opioid consumption and improving clinical outcome in PAO patients. Patients and Methods: We conducted a two-group randomized-controlled trial in 42 consecutive patients undergoing a PAO for symptomatic developmental dysplasia of the hip (DDH). The study group received an ultrasound-guided TAP block with 20 mL of 0.75% ropivacaine prior to surgery. The control group did not receive a TAP block. All patients received a multimodal analgesia with nonsteroidal anti-inflammatory drugs (NSAID) (etoricoxib and metamizole) and an intravenous patient-controlled analgesia (PCA) with piritramide (1.5 mg bolus, 10 min lockout-time). The primary endpoint was opioid consumption within 48 h after surgery. Secondary endpoints were pain scores, assessment of postoperative nausea and vomiting (PONV), measurement of the quality of recovery using patient-reported outcome measure and length of hospital stay. Forty-one patients (n = 21 TAP block group, n = 20 control group) completed the study, per protocol. One patient was lost to follow-up. Thirty-three were women (88.5%) and eight men (19.5%). The mean age at the time of surgery was 28 years (18–43, SD ± 7.4). All TAP blocks were performed by an experienced senior anaesthesiologist and all operations were performed by a single, high volume surgeon. Results: The opioid consumption in the TAP block group was significantly lower compared to the control group at 6 (3 mg ± 2.8 vs. 10.8 mg ± 5.6, p < 0.0001), 24 (18.4 ± 16.2 vs. 30.8 ± 16.4, p = 0.01) and 48 h (29.1 mg ± 30.7 vs. 54.7 ± 29.6, p = 0.04) after surgery. Pain scores were significantly reduced in the TAP block group at 24 h after surgery. There were no other differences in secondary outcome parameters. No perioperative complication occurred in either group. Conclusion: Ultrasound-guided TAP block significantly reduces the perioperative opioid consumption in patients undergoing PAO.

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Evaluation of the nature and etiologies of risk factors for diaphyseal atypical femoral fractures

Medical Principles and Practice ◽

10.1159/000517484 ◽

2021 ◽

Author(s):

Hiroyuki Tsuchie ◽

Naohisa Miyakoshi ◽

Yuji Kasukawa ◽

Koji Nozaka ◽

Kimio Saito ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analyses ◽

Femoral Fractures ◽

Japanese Patients ◽

High Serum ◽

Control Group ◽

Atypical Femoral Fractures ◽

Factors Affecting ◽

Lateral Curvature ◽

Low Serum

Objectives: Differences in the mechanisms of subtrochanteric and diaphyseal atypical femoral fractures (AFFs) have been speculated in studies that have analyzed differences in the patients’ backgrounds. However, the etiologies of each type of AFF have not been investigated in detail. Therefore, this study aimed to investigate the nature and etiologies of the risk factors for diaphyseal AFFs. Materials and Methods: Eighty consecutive Japanese patients with 91 diaphyseal AFFs (the AFF group) and 110 age-matched female patients with osteoporosis (the non-AFF control group) were included. Their clinical data were compared and the factors affecting AFFs were investigated. Furthermore, the etiologies of the risk factors for diaphyseal AFFs were examined. Results: Multivariate analysis revealed that femoral serrated changes, bisphosphonate or denosumab usage, and lateral and anterior femoral curvatures were the risk factors for diaphyseal AFFs (p<0.0011, p=0.0137, and p<0.0001, respectively). Multivariate analyses also revealed that serrated changes and low serum 25(OH)D levels affected the lateral curvature (p=0.0088 and 0.0205, respectively), while serrated changes affected the anterior curvature (p=0.0006); each significantly affected the femoral curvature. In addition, a high serum calcium (Ca) level, lateral femoral curvature, and anterior femoral curvature were the predictors of serrated changes (p=0.0146, 0.0002, and 0.0098, respectively). Conclusion: The risk factors for diaphyseal AFFs were bone resorption inhibitor usage, a strong femoral curvature, and serrated changes. A low serum 25(OH)D level and serrated changes are the risk factors for lateral curvature, while a high serum Ca level is a risk factor for serrated changes.

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Multi-Drug Resistant Organisms Infection Impact on Patients Length of Stay in Respiratory Care Ward

Antibiotics ◽

10.3390/antibiotics10050608 ◽

2021 ◽

Vol 10 (5) ◽

pp. 608

Author(s):

Yi-Ping Chen ◽

Xian-Wen Tasi ◽

Ko Chang ◽

Xuan-Di Cao ◽

Jung-Ren Chen ◽

...

Keyword(s):

Pathogenic Bacteria ◽

Length Of Hospital Stay ◽

Selective Medium ◽

Respiratory Care ◽

Control Group ◽

Resistant Organism ◽

Case Group ◽

Drug Resistant ◽

Factors Affecting ◽

Care Ward

This study aimed to investigate the effects of multi-drug-resistant organism (MDRO) infection and other factors on the length of hospital stay (LOS) of patients in the respiratory care ward (RCW) of a regional hospital in Taiwan. In this retrospective study, we collected cases from MDRO-infected patients in the RCW from January 2016 to March 2020. The RCW comprises 13 beds in total. There were 106 infected patients, of which 42 were in the case group (infected with MDROs) and 64 were in the control group (not infected with MDROs). Clinical specimens were inoculated in a selective medium to isolate the pathogenic bacteria by standard procedures. The results showed the main factors affecting the LOS were: patients with MDRO infection, patients discharged from the RCW, and patients who underwent catheterization. The LOS of patients infected with MDROs was significantly longer than that of patients without MDRO infection (β = 0.55, 95% CI = 0.02–1.09), with the case group and the control group being 479.8 ± 546.5 and 307.3 ± 436.2 days, respectively. Infection with carbapenem-resistant Pseudomonas aeruginosa (CRPA) was associated with a longer LOS than other MDRO strains. These findings have important implications for infection control in RCW and in better tracking the health of patients.

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Chronic Exposure to Lead and Cadmium in Residents Living near a Zinc Smelter

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041731 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1731

Author(s):

HyeJeong Jo ◽

GeunBae Kim ◽

JunYoung Chang ◽

Kwan Lee ◽

ChulWoo Lee ◽

...

Keyword(s):

Health Management ◽

Control Group ◽

Exposure Group ◽

Factors Affecting ◽

Adverse Health Effects ◽

Lead And Cadmium ◽

Exposure Levels ◽

Male Sex ◽

Locally Grown ◽

Cd Exposure

This study aimed to measure lead (Pb) and cadmium (Cd) exposure levels in residents living near a zinc (Zn) smelter in Seokpo-myeon, Bonghwa-gun, South Korea, and identify factors affecting exposure. Residents aged ≥20 years living within 3 km and ≥30 km away from the smelter were classified as the exposure group (n = 549), and the control group (n = 265), respectively. Data were obtained through a questionnaire survey. Blood Pb levels in the exposure group (4.19 µg/dL) were higher than in the control group (2.70 µg/dL). The exposure group (1.32 µg/L) also had higher urinary Cd concentrations than the control group (0.80 µg/L). Male sex, older age, previous work at the smelter, smoking, and proximity to the smelter were associated with higher blood Pb levels on multivariate analysis; urinary Cd concentration was significantly higher in women, those who were older, those with experience of working in a Zn smelter or mine, those with proximity to the Zn smelter, and those who consumed locally grown vegetables. In conclusion, Zn smelters are major source of Pb and Cd pollution and require ongoing public health management to prevent potential adverse health effects.

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Ultrasound-Guided Funicular Block: Ropivacaine Injection into the Tissue around the Spermatic Cord to Improve Analgesia during Orchiectomy in Dogs

Animals ◽

10.3390/ani11051275 ◽

2021 ◽

Vol 11 (5) ◽

pp. 1275

Author(s):

Vincenzo Cicirelli ◽

Pasquale Debidda ◽

Nicola Maggio ◽

Michele Caira ◽

Giovanni M. Lacalandra ◽

...

Keyword(s):

Postoperative Pain ◽

General Anaesthesia ◽

Spermatic Cord ◽

Postoperative Pain Management ◽

Control Group ◽

Ultrasound Guided ◽

Hemodynamic Stability ◽

Pain Scores ◽

Lower Pain ◽

Ropivacaine Hydrochloride

Orchiectomy is a common surgical procedure performed on small animals, and it requires postoperative pain management despite its relative simplicity. This study aimed to evaluate the hemodynamic stability, intraoperative administration of additional hypnotic and/or analgesic drugs, and postoperative pain scores following the combination of ultrasound-guided injection of ropivacaine hydrochloride into the spermatic cord and infiltration by the same anaesthetic of the incisional prescrotal line (ROP) or general anaesthesia. Dogs in the ROP group showed greater intraoperative hemodynamic stability and lower pain scores than the control group. The locoregional approach used in this study proved effective in minimising the responses to the surgical stimulus and ensured adequate analgesia intra- and postoperatively. This method, called ultrasound-guided funicular block, allows orchiectomy to be performed under deep sedation without general anaesthesia.

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Effect of B-ultrasound-guided nerve block on nerve block on analgesia and sedation in patients with acute cholecystitis undergoing puncture and drainage

Tobacco Regulatory Science ◽

10.18001/trs.7.5.1.72 ◽

2021 ◽

Vol 7 (5) ◽

pp. 3022-3028

Author(s):

Fei Guo ◽

Yongjun Wang ◽

Shenghui Liu ◽

Junrong Cao

Keyword(s):

Oxidative Stress ◽

Heart Rate ◽

Acute Cholecystitis ◽

Nerve Block ◽

Sedation Score ◽

The Body ◽

Control Group ◽

Observation Group ◽

Ultrasound Guided ◽

Total Antioxidant

To investigate the effect of B-ultrasound-guided nerve block on analgesia and sedation in patients with acute cholecystitis undergoing puncture and drainage. Methods 96 patients with acute cholecystitis who underwent puncture and drainage from May 2018 to November 2020 were randomly divided into control group and observation group by random number table method, with 48 cases in each group. The patients in the control group were anesthetized by local infiltration. The patients in the observation group were anesthetized by B-ultrasound-guided nerve block. Heart rate, blood pressure, analgesia score, sedation score, and oxidative stress level were compared between the two groups. Results At the time of puncture (T2), heart rate (HR) and mean arterial pressure (MAP) in the two groups were significantly lower than those before operation (T1) (P<0.05); at the end of operation (T3), HR and MAP in the control group were significantly higher than those at T1 (P<0.05); at T2, HR and MAP in the observation group were significantly higher than those in the control group (P<0.05); at T3, HR and MAP in the observation group were significantly lower than those in the control group (P<0.05). AtT2 and T3, Ramsay sedation score in both groups was significantly lower than that at T1 (P<0.05), while Ramsay score in the observation group was significantly higher than that in control group (P<0.05); atT2 and T3, visual analog scale (VAS) pain score in both groups was significantly higher than that at T1 (P<0.05), while VAS score in the observation group was significantly lower than that in the control group (P<0.05). After operation, the levels of serum malondialdehyde (MDA) and superoxide dismutase (SOD) in the two groups were significantly higher than those before operation (P<0.05), and the levels of serum total antioxidant capacity (T-AOC) were significantly lower than those before operation (P<0.05); after operation, the levels of serum SOD and T-AOC in the observation group were significantly higher than those in the control group (P<0.05), and the levels of MDA in the observation group were significantly lower than those in the control group (P>0.05). Conclusion B-ultrasound-guided nerve block anesthesia can maintain the stable hemodynamic index of patients with acute cholecystitis undergoing puncture and drainage therapy, improve the analgesic and sedative effect and reduce the oxidative stress response of the body.

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The lesion detection efficacy of deep learning on automatic breast ultrasound and factors affecting its efficacy: a pilot study

British Journal of Radiology ◽

10.1259/bjr.20210438 ◽

2021 ◽

Author(s):

Xiao Luo PhD ◽

Min Xu ◽

Guoxue Tang ◽

Yi Wang PhD ◽

Na Wang ◽

...

Keyword(s):

Deep Learning ◽

Breast Tissue ◽

Test Group ◽

Lesion Size ◽

Breast Ultrasound ◽

Lesion Detection ◽

Detection Sensitivity ◽

Control Group ◽

Factors Affecting ◽

Handheld Ultrasound

Objectives: The aim of this study was to investigate the detection efficacy of deep learning (DL) for automatic breast ultrasound (ABUS) and factors affecting its efficacy. Methods: Women who underwent ABUS and handheld ultrasound from May 2016 to June 2017 (N = 397) were enrolled and divided into training (n = 163 patients with breast cancer and 33 with benign lesions), test (n = 57) and control (n = 144) groups. A convolutional neural network was optimised to detect lesions in ABUS. The sensitivity and false positives (FPs) were evaluated and compared for different breast tissue compositions, lesion sizes, morphologies and echo patterns. Results: In the training set, with 688 lesion regions (LRs), the network achieved sensitivities of 93.8%, 97.2 and 100%, based on volume, lesion and patient, respectively, with 1.9 FPs per volume. In the test group with 247 LRs, the sensitivities were 92.7%, 94.5 and 96.5%, respectively, with 2.4 FPs per volume. The control group, with 900 volumes, showed 0.24 FPs per volume. The sensitivity was 98% for lesions > 1 cm3, but 87% for those ≤1 cm3 (p < 0.05). Similar sensitivities and FPs were observed for different breast tissue compositions (homogeneous, 97.5%, 2.1; heterogeneous, 93.6%, 2.1), lesion morphologies (mass, 96.3%, 2.1; non-mass, 95.8%, 2.0) and echo patterns (homogeneous, 96.1%, 2.1; heterogeneous 96.8%, 2.1). Conclusions: DL had high detection sensitivity with a low FP but was affected by lesion size. Advances in knowledge: DL is technically feasible for the automatic detection of lesions in ABUS.

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ERAS Improves Postoperative Recovery in Children

10.21203/rs.3.rs-736991/v1 ◽

2021 ◽

Author(s):

Tingmei Wu ◽

Haiwen Li ◽

Huixia Zhou ◽

Xuemei Hao ◽

Xiaojun Wang ◽

...

Keyword(s):

Inflammatory Cytokine ◽

Enhanced Recovery ◽

Length Of Hospital Stay ◽

Final Analysis ◽

Postoperative Recovery ◽

Controlled Study ◽

Control Group ◽

Robot Assisted ◽

Cytokine Levels ◽

Eras Protocol

Abstract Objective: Enhanced recovery after surgery (ERAS) protocols are established in adults but not fully evaluated in children. This study investigated whether an ERAS protocol improved recovery and influenced postoperative inflammatory cytokine levels in children undergoing surgery for hydronephrosis. Methods: This randomized controlled study included patients who underwent robot-assisted laparoscopic surgery for hydronephrosis at Bayi Children's Hospital (Beijing, China) between October 2018 and September 2019. Patients were randomized to an ERAS group (perioperative ERAS protocol) or control group (standard perioperative management). Outcomes related to postoperative recovery and inflammatory cytokine levels were evaluated. Results: The final analysis included 18 patients in each group. Five patients (27.78%) in each group experienced postoperative complications (abdominal pain, nausea and vomiting, subcutaneous emphysema or fever). The ERAS group had a shorter time to first postoperative flatus than the control group (25 vs. 49 hours; P =0.009), although the time for abdominal drainage flow to reach ≤20 mL/day, time to urinary catheter removal and length of hospital stay did not differ significantly between groups. Preoperative plasma cytokine levels were comparable between groups. Compared with the control group, the ERAS group had a higher IL-6 level on postoperative day 2 ( P <0.05) and a lower concentration of IL-1β on postoperative days 1 and 2 ( P <0.05). Postoperative levels of CRP, TNFα and IL-10 did not differ significantly between groups. Conclusions: ERAS may accelerate postoperative recovery and modulate the postoperative inflammatory response in pediatric patients undergoing robot-assisted laparoscopic pyeloplasty for hydronephrosis.

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