BackgroundNewly developed atrial fibrillation (AF) in patients who have undergone an esophagectomy increases the incidence of postoperative complications. However, the clinical implications of AF have not been fully elucidated in these patients. This retrospective observational study investigated the predictors for AF and the effect of AF on the mortality in esophageal cancer patients undergoing esophagectomy.MethodsThis study evaluated 583 patients undergoing esophagectomy, from January 2005 to April 2012. AF was defined as newly developed postoperative AF requiring treatment. The risk factors for AF and the association between AF and mortality were evaluated. The long-term mortality was the all-cause mortality, for which the cutoff date was May 31, 2014.ResultsAF developed in 63 patients (10.8%). Advanced age (odds ratio [OR] 1.099, 95% confidence interval [CI] 1.056–1.144, P < 0.001), preoperative calcium channel blocker (CCB) (OR 2.339, 95% CI 1.143–4.786, P = 0.020), and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) (OR 0.206, 95% CI 0.067–0.635, P = 0.006) were associated with the incidence of AF. The Kaplan-Meier curve showed a significantly lower survival rate in the AF group compared to the non-AF group (P = 0.045), during a median follow-up of 50.7 months. The multivariable analysis revealed associations between AF and the 1-year mortality (hazard ratio [HR] 2.556, 95% CI 1.430–4.570, P = 0.002) and between AF and the long-term mortality (HR 1.507, 95% CI 1.003–2.266, P = 0.049).ConclusionsIn esophageal cancer patients, the advanced age and the preoperative medications (CCB, ACEI or ARB) were associated with the incidence of AF. Furthermore, postoperatively developed AF was associated with mortality in esophageal cancer patients after esophagectomy, suggesting that a close surveillance might be required in patients who showed AF during postoperative period.

In this retrospective study, clinical data including clinical manifestations, routine blood tests, chest radiographic imaging from 77 severe cases of SARS treated with integrated Chinese and Western medicine were collected and statistically analyzed. Twenty-nine (37.6%) patients were admitted to the intensive care unit, non-invasive ventilation was used in 40 (51.9%) cases, and invasive ventilatory procedure was performed in eight (10.3%) cases. Seventy (90.9%) patients were clinically cured and seven (9.0%) died. The duration of defervescence was 8.3 +/- 5.0 days after admission. In the early stage, normal leucocyte count was seen in 46 (75.4%) of the 61 patients tested, decreased leucocyte count in 13 (21.3%) and elevated leucocyte count in only two (3.2%) cases. A decreased lymphocyte count was also seen in 23 (37.7%) cases of the 61 patients tested on admission, and by day 14, the number of patients with decreased lymphocyte count (1.11 +/- 0.66 x 10(9)) increased to 32 (47.7%) in 67 cases examined. Neutral granulocyte count was normal or decreased in 58 (95.0%) patients on admission, but elevated from the 7th day onward and peaked on day 21 in 32 (65.3%) of the 49 cases tested. All of the blood abnormalities returned to normal in the convalescent stage. Twenty-nine (37.6%) of the 77 severe cases of SARS patients demonstrated an extensive lung involvement. In comparison with the non-severe SARS cases, this group of patients showed significantly more pneumonic air-space opacities and ground glass-like changes on the chest radiographs (p < 0.05, chi2 test). The role Chinese medicine played in the treatment of SARS was discussed.

BackgroundPositive end-expiratory pressure (PEEP) can increase intracranial pressure. Pneumoperitoneum and the Trendelenburg position are associated with an increased intracranial pressure. We investigated whether PEEP ventilation could additionally influence the sonographic optic nerve sheath diameter as a surrogate for intracranial pressure during pneumoperitoneum combined with the Trendelenburg position in patients undergoing robot-assisted laparoscopic prostatectomy.MethodsAfter anesthetic induction, 38 patients were randomly allocated to a low tidal volume ventilation (8 ml/kg) without PEEP group (zero end-expiratory pressure [ZEEP] group, n = 19) or low tidal volume ventilation with 8 cmH2O PEEP group (PEEP group, n = 19). The sonographic optic nerve sheath diameter was measured prior to skin incision, 5 min and 30 min after pneumoperitoneum and the Trendelenburg position, and at the end of surgery. The study endpoint was the difference in the sonographic optic nerve sheath diameter 5 min after pneumoperitoneum and the Trendelenburg position between the ZEEP and PEEP groups.ResultsOptic nerve sheath diameters 5 min after pneumoperitoneum and the Trendelenburg position did not significantly differ between the groups [least square mean (95% confidence interval); 4.8 (4.6–4.9) mm vs 4.8 (4.7–5.0) mm, P = 0.618]. Optic nerve sheath diameters 30 min after pneumoperitoneum and the Trendelenburg position also did not differ between the groups [least square mean (95% confidence interval); 4.5 (4.3–4.6) mm vs 4.5 (4.4–4.6) mm, P = 0.733].ConclusionsAn 8 cmH2O PEEP application under low tidal volume ventilation does not induce an increase in the optic nerve sheath diameter during pneumoperitoneum combined with the steep Trendelenburg position, suggesting that there might be no detrimental effects of PEEP on the intracranial pressure during robot-assisted laparoscopic prostatectomy.Trial RegistrationClinicalTrial.gov NCT02516566

BackgroundThe FloTrac/Vigileo™ system does not thoroughly reflect variable arterial tones, due to a lack of external calibration. The ability of this system to measure stroke volume and track its changes after fluid administration has not been fully evaluated in patients with the high systemic vascular resistance that can develop during laparoscopic surgery.MethodsIn 42 patients undergoing laparoscopic prostatectomy, the stroke volume derived by the third-generation FloTrac/Vigileo™ system (SV-Vigileo), the stroke volume measured using transesophageal echocardiography (SV-TEE) as a reference method, and total systemic vascular resistance were evaluated before and after 500 ml fluid administration during pneumoperitoneum combined with the Trendelenburg position.ResultsTotal systemic vascular resistance was 2159.4 ± 523.5 dyn·s/cm5 before fluid administration. The SV-Vigileo was significantly higher than the SV-TEE both before (68.8 ± 15.9 vs. 57.0 ± 11.0 ml, P < 0.001) and after (73.0 ± 14.8 vs. 64.9 ± 12.2 ml, P = 0.003) fluid administration. During pneumoperitoneum combined with the Trendelenburg position, Bland-Altman analysis for repeated measures showed a 53.8% of percentage error between the SV-Vigileo and the SV-TEE. Four-quadrant plot (69.2% of a concordance rate) and polar plot analysis (20.6° of a mean polar angle, 16.4° of the SD of a polar angle, and ±51.5° of a radial sector containing 95% of the data points) did not indicate a good trending ability of the FloTrac/Vigileo™ system.ConclusionsThe third-generation FloTrac/Vigileo™ system may not be useful in patients undergoing laparoscopic surgery, based on unreliable performance in measuring the stroke volume and in tracking changes in the stroke volume after fluid administration during pneumoperitoneum combined with the Trendelenburg position.

Background. Although fluoroscopic guidance is recommended highly for more accurate lumbar interlaminar epidural steroid injection (L-ESI), many physicians still use a nonimage-guided approach for L-ESIs. However, because of its associated risk of radiation and increased medical expense, the cost-effectiveness and safety of fluoroscopy-guided ESI have been called into question. The goal of this retrospective matched paired analysis in the same individuals was to assess the effectiveness and prevalence of complications of nonimage-guided L-ESI compared to those of fluoroscopy-guided L-ESI. Methods. Between 2015 and 2016, 94 patients who received both nonimage- and fluoroscopy-guided L-ESIs were analyzed retrospectively. The changes of the numeric rating scale (NRS) in pain intensity and functional outcome and the differences in the number of complications between blind and fluoroscopy-guided L-ESIs in the same individuals were evaluated by a matched paired analysis. Results. Of the 94 patients, the differences in NRS before and after the procedure were 1.29 (95% confidence interval (CI) = 0.94–1.65) for the nonimage-guided group and 1.64 (95% CI = 1.28–2.01) for the fluoroscopy-guided group (p=0.16). More subjective functional improvement was observed in fluoroscopy-guided L-ESI (57, 60.6%) than in nonimage-guided L-ESI (47, 50.0%) without statistical significance (p=0.16). Nine (9.6%) patients in the nonimage-guided group experienced complications related to the procedure overall compared to 4 (4.3%) in the fluoroscopy-guided group (p=0.27). Conclusions. In this study, both blind and image-guided L-ESI techniques included similar extents of postprocedural outcomes and complications. Physicians should consider the risks associated with the two different techniques overall and develop ways to individualize the procedure to decrease the risk of complications and improve the positive outcomes of lumbar epidural steroid injections.

Background: In most of the cases, antibiotic cement is recommended to fill the dead space after debridement of osteomyelitis. As to local Cierny-Mader Type IV tibial osteomyelitis, radical debridement of the infected bone can be achieved, after that, is it still necessary to apply antibiotic cement to the dead space? This study was aimed to answer the question.Methods: From January 2010 to January 2015, 64 patients with local Cierny-Mader Type IV tibial osteomyelitis were included and randomly divided into two groups. Patients in the cement group were treated with antibiotic-impregnated bone cement after radical debridement of the infected bone (cement group), while the other patients in the without cement group were not applied any cement after the same debridement (without cement group). Both groups were operated by the same surgical team and applied Ilizarov bone transport to fill the bone defect.Result: All patients in both groups achieved successful healing with bone union at both corticotomy and tibial docking sites. At the end of follow-up，there was one case of infection recurrence in each groups. There were no differences in demographics and clinical variables between the two groups. There was also no difference either in terms of bone results or functional results between the two groups (c 2=0.006 for bone results and c 2=1.339 for functional results). But there was significant difference in terms of total hospitalization expenses between the two groups (P＜0.001, the cement group was much higher than the without cement group).Conclusion: When radical debridement is achieved in dealing with local Cierny-Mader Type IV tibial osteomyelitis, it is no need to apply antibiotics cement in the dead space, but it needs more cases to increase the convincingness.Trial registration: ChiCTR-TNRC-10002837，retrospectively registered.