Time filter

Source Type

Wu X.,Jinhua Municipal Central Hospital | Jin Y.,Shanghai JiaoTong University | Zhang X.,Shanghai JiaoTong University
Journal of Craniofacial Surgery | Year: 2014

Rupture of traumatic pseudoaneurysms of the middle meningeal artery (MMA) usually causes extradural hematoma. In rare cases, it may be a possible cause of intraparenchymal hematoma. We present 2 cases of intraparenchymal hematoma caused by rupture of traumatic pseudoaneurysms of MMA. Both patients had definite medical history of head trauma. Imaging examinations indicated temporal hematoma or frontal hematoma caused by rupture of pseudoaneurysm of MMA. After surgical management, both the patients had a favorable prognosis. The formation of the traumatic pseudoaneurysms, imaging findings, and the management were discussed, and we conclude that in the management of traumatic intraparenchymal hematoma, possibility of traumatic pseudoaneurysms must be considered. Surgery may be the prior choice for the treatment of traumatic pseudoaneurysms. © 2014 Mutaz B. Habal.

Chen Y.H.,Jinhua Municipal Central Hospital
Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine / Zhongguo Zhong xi yi jie he xue hui, Zhongguo Zhong yi yan jiu yuan zhu ban | Year: 2012

To study and compare the therapeutic effects of electroacupuncture and probiotics combine Deanxit in treating diarrhea predominant irritable bowel syndrome (D-IBS). Totally 64 D-IBS patients accompanied with anxiety and/or depression were randomly assigned to the Western medicine group (Group A) and the electroacupuncture (EA) group (Group B), 30 patients in Group A and 34 patients in Group B. Patients in Group A took Bacillus licheniformis and Deanxit, while those in Group B received EA. Four weeks consisted of one therapeutic course. Three-month follow-up was carried out. The scoring for the digestive tract symptoms, HAMA score, and HAMD score were evaluated before and after treatment. The recurrence in the 3-month follow-up was also observed. The total effect rate was 86.67% in Group A and 88.24% in Group B with no statistical difference between the two groups (P > 0.05). There was statistical difference in the scoring for the digestive tract symptoms, HAMA score, and HAMD score (P < 0.05, P < 0.01). There was no statistical difference in the improvement of defecation frequency score, HAMA score, HAMD score between the two groups after treatment (P > 0.05). Better effects on improving abdominal pain score and abdominal distention score was obtained in Group B (P < 0.01), while better effects on improving the stool form score and mucus score were obtained in Group A (P < 0.01). There was no statistical difference in the recurrence rate between the two groups within the two-month follow-up (P > 0.05). The recurrence rate within the 3-month follow-up was obviously lower in Group B than in Group A (P < 0.05). EA and Western medicine (probiotics combined Deanxit) could effectively treat D-IBS patients accompanied with anxiety and/or depression. Both of them had different superiorities in improving symptoms. But EA had better long-term therapeutic effects.

Zhang Z.,Jinhua Municipal Central Hospital | Lu B.,Jinhua Municipal Central Hospital | Sheng X.,Jinhua Municipal Central Hospital | Jin N.,Jinhua Municipal Central Hospital
American Journal of Kidney Diseases | Year: 2011

Background: Cystatin C (CysC) has been proposed as a filtration marker for the early detection of acute kidney injury (AKI); however, a wide range of its predictive accuracy has been reported. Study Design: Meta-analysis of diagnostic test studies. Setting & Population: Various clinical settings of AKI, including patients after cardiac surgery, pediatric patients, and critically ill patients. Selection Criteria: Computerized search of PubMed, Current Contents, CINAHL, and EMBASE from inception until November 15, 2010, was performed to identify potentially relevant articles. Inclusion criteria were studies investigating the diagnostic accuracy of CysC level to predict AKI. There were no language restrictions in the search. Index Tests: Increasing or increased serum CysC level or urinary CysC excretion. Reference Tests: The outcome was the development of AKI, primarily based on serum creatinine level (definition varied across studies). Results: We analyzed data from 19 studies and 11 countries involving 3,336 patients. Of these studies, 13 could be included in the meta-analysis. Across all settings, the diagnostic OR for serum CysC level to predict AKI was 23.5 (95% CI, 14.2-38.9), with sensitivity and specificity of 0.84 and 0.82, respectively. The area under the receiver operating characteristic curve (AUROC) of serum CysC level to predict AKI was 0.96 (95% CI, 0.95-0.97). Subgroup analysis showed that serum CysC was of diagnostic value when measured early (within 24 hours after renal insult or intensive care unit admission). For the diagnostic value of urinary CysC excretion, the diagnostic OR was 2.60 (95% CI, 2.01-3.35), with sensitivity and specificity of 0.52 and 0.70, respectively. The AUROC of urinary CysC excretion to predict AKI was 0.64 (95% CI, 0.62-0.66). Limitations: Variation in criteria for definitions of index and reference tests, absence of measured glomerular filtration rate in most studies. Conclusion: Serum CysC appears to be a good biomarker in the prediction of AKI, whereas urinary CysC excretion has only moderate diagnostic value. © 2011 National Kidney Foundation, Inc.

Zhang Z.,Jinhua Municipal Central Hospital | Xu X.,Jinhua Municipal Central Hospital | Ni H.,Jinhua Municipal Central Hospital | Deng H.,Jinhua Municipal Central Hospital
Journal of Thoracic Disease | Year: 2013

Background and objectives: Red cell distribution width (RDW) is a variability of red cell sizes and has been associated with outcomes in many clinical settings. Its prognostic value in intensive care unit (ICU) has been reported but requires confirmation. The study aimed to investigate the role of RDW in predicting hospital mortality in critically ill patients. Methods: This is a retrospective study conducted in a 24-bed ICU of a tertiary teaching hospital. Data on demographic characteristics and laboratory measurements were collected from medical information database. Baseline variables were compared between survivors and nonsurvivors. The primary endpoint was hospital mortality; and ICU length of stays (LOS) were compared between patients with RDW >14.8% and ≤14.8%. The predictive value of RDW was also measured using receiver operating characteristic (ROC) curves. Two-sided P<0.05 was considered to be statistically significant. Results: A total of 1,539 patients were enrolled during study period, including 1,084 survivors and 455 nonsurvivors. In univariate analysis, variables such as age, sex, primary diagnosis, C-reactive protein (CRP), RDW and albumin were significantly associated with hospital mortality. RDW remained significantly associated with mortality after adjustment for sex, age, Charlson index albumin and CRP, with an odds ratio of 1.1 (95% CI: 1.03-1.16). Diagnostic performance of RDW in predicting mortality appeared to be suboptimal (AU-ROC: 0.62). Changes in RDW during a short follow up period were not associated with mortality. Conclusions: RDW measured on ICU entry is associated with hospital mortality. Patients with higher RDW will have longer LOS in ICU. Repeated measurements of RDW provide no additional prognostic value in critically ill patients. © Pioneer Bioscience Publishing Company.

Zhang Z.,Jinhua Municipal Central Hospital | Xu X.,Jinhua Municipal Central Hospital | Ding J.,Jinhua Municipal Central Hospital | Ni H.,Jinhua Municipal Central Hospital
Nutrition in Clinical Practice | Year: 2013

Background and Objective: Enteral feeding is vital in the critical care setting; however, the optimal route of enteral feeding (postpyloric vs gastric feeding) remains debated. We aimed to systematically review the current evidence to see whether postpyloric feeding could provide additional benefits to intensive care unit (ICU) patients. Method: Randomized controlled trials (RCTs) comparing the efficacy and safety of postpyloric feeding vs gastric feeding were included in our systematic review. Odds ratio (OR) was used for binary outcome data and weighted mean difference (WMD) was used for continuous outcome data. Summary effects were pooled using a fixed or random effects model as appropriate. Results: Seventeen RCTs were included in our meta-analysis. Postpyloric tube feeding could deliver higher proportions of estimated energy requirement (WMD, 12%; 95% confidence interval [CI], 5%-18%) and reduce the gastric residual volume (GRV) (WMD, -169.1 mL; 95% CI, -291.995 to -46.196 mL). However, the meta-analysis failed to demonstrate any benefits to critically ill patients with postpyloric tube feeding in terms of mortality (OR, 1.05; 95% CI, 0.77-1.44), new-onset pneumonia (OR, 0.77; 95% CI, 0.53-1.13), and aspiration (OR, 1.20; 95% CI, 0.64-2.25). There was no significant publication bias as represented by an Egger's bias coefficient of 0.21 (95% CI, -1.01 to 1.43; P =.7). Conclusion: As compared with gastric feeding, postpyloric feeding is able to deliver higher proportions of the estimated energy requirement and can help reduce the GRV. © 2013 American Society for Parenteral and Enteral Nutrition.

Shao M.-J.,Jinhua Municipal Central Hospital | Hu M.-X.,Jinhua Municipal Central Hospital | Hu M.,Jinhua Municipal Central Hospital
Journal of Minimally Invasive Gynecology | Year: 2013

Study Objective: To describe temporary bilateral uterine artery occlusion with titanium clips in combination with vasopressin as an effective surgical intervention to control hemorrhage during laparoscopic management of cesarean scar pregnancies (CSPs). Design: Retrospective study (Canadian Task Force classification III). Setting: University hospital in an obstetrics and gynecology department. Interventions: Five patients with CSPs underwent removal of gestational ectopic masses via laparoscopy. At the beginning of the procedure, all 5 women had temporary bilateral uterine artery occlusion with titanium clips, and vasopressin 6 U was injected into the myometrium. Measurements and Main Results: Clinical data, serum β-human chorionic gonadotropin levels, operative times, and operative blood loss levels were recorded. The mean gestational age at the time of CSP diagnosis was 9.2 ± 1.9 weeks. The mean serum β-hCG level on the day of surgery was 14262 ± 12870 IU/L. The mean operative time was 86 ± 21.6 minutes, the mean uterine artery occlusion time was 58 ± 13.8 minutes, and the mean blood loss was 144 ± 79.6 mL. No cases were converted to laparotomy, no blood transfusions were required, and there were no complications. Conclusions: Laparoscopy combined with titanium clip occlusion of the uterine arteries bilaterally with vasopressin injection is an effective, minimally invasive procedure to preserve the uterus in patients with a CSP. © 2013 AAGL.

Zhang Z.,Jinhua Municipal Central Hospital | Xu X.,Jinhua Municipal Central Hospital | Ni H.,Jinhua Municipal Central Hospital
Critical Care | Year: 2012

Introduction: Small-study effects refer to the fact that trials with limited sample sizes are more likely to report larger beneficial effects than large trials. However, this has never been investigated in critical care medicine. Thus, the present study aimed to examine the presence and extent of small-study effects in critical care medicine.Methods: Critical care meta-analyses involving randomized controlled trials and reported mortality as an outcome measure were considered eligible for the study. Component trials were classified as large (≥100 patients per arm) and small (<100 patients per arm) according to their sample sizes. Ratio of odds ratio (ROR) was calculated for each meta-analysis and then RORs were combined using a meta-analytic approach. ROR<1 indicated larger beneficial effect in small trials. Small and large trials were compared in methodological qualities including sequence generating, blinding, allocation concealment, intention to treat and sample size calculation.Results: A total of 27 critical care meta-analyses involving 317 trials were included. Of them, five meta-analyses showed statistically significant RORs <1, and other meta-analyses did not reach a statistical significance. Overall, the pooled ROR was 0.60 (95% CI: 0.53 to 0.68); the heterogeneity was moderate with an I2of 50.3% (chi-squared = 52.30; P = 0.002). Large trials showed significantly better reporting quality than small trials in terms of sequence generating, allocation concealment, blinding, intention to treat, sample size calculation and incomplete follow-up data.Conclusions: Small trials are more likely to report larger beneficial effects than large trials in critical care medicine, which could be partly explained by the lower methodological quality in small trials. Caution should be practiced in the interpretation of meta-analyses involving small trials. © 2013 Zhang et al.; licensee BioMed Central Ltd.

Zhang Z.,Jinhua Municipal Central Hospital | Ni H.,Jinhua Municipal Central Hospital | Lu B.,Jinhua Municipal Central Hospital
ASAIO Journal | Year: 2012

One of the greatest problems in performing continuous renal replacement therapy (CRRT) is premature coagulation of the circuit. The aim of the current study was to monitor the circuit function prospectively and analyze patient-related variables that may affect circuit life. Critically ill patients admitted to the intensive care unit of a tertiary hospital between August 2010 and August 2011 receiving continuous veno-venous hemofiltration (CVVH) with systemic heparin anticoagulation were prospectively studied. Variables including body temperature, blood pH value, ionized calcium level, activated partial thromboplastin time (aPTT), prothrombin time (PT), platelet count, and heparin dose were collected and analyzed for their association with circuit life span. Fifty-four patients treated by CVVH were included, with 255 filters. The filter life was 29.7 ± 13.4 hours (mean ± standard deviation [SD]). Circuits with longer survival time appeared to have lower body temperature (37.80 ± 1.14 vs. 36.36 ± 1.09; p< 0.05), lower levels of serum ionized calcium (0.80 vs. 1.29; p< 0.05), and to be more acidic (7.233 vs. 7.377; p< 0.05). Cox regression showed that pH value and ionized calcium levels were significantly associated with circuit life. Other variables of hematocrit, albumin levels, platelet count, aPTT, PT, or dose of heparin were not significantly associated with circuit life. © 2012 by the American Society for Artificial Internal Organs.

Wang C.-F.,Jinhua Municipal Central Hospital | Hu M.,Jinhua Municipal Central Hospital
Journal of Minimally Invasive Gynecology | Year: 2015

Abnormal uterine bleeding and other gynecologic complications associated with a previous cesarean section scar are only recently being identified and described. Herein we report a rare case of a woman with recurring massive uterine bleeding after 2 cesarean sections. Curettage and hormone therapy were unsuccessfully used in an attempt to control the bleeding. After she was transferred to our hospital, she had another episode of vaginal bleeding that was successfully managed with oxytocin and hemostatic. Diagnostic hysteroscopy performed under anesthesia revealed an abnormal transected artery in the cesarean section scar with a thrombus visible. In the treatment at the beginning of laparoscopic management, we adopted temporary bilateral uterine artery occlusion with titanium clips to prevent massive hemorrhage. Secondly, with the aid of hysteroscopy, the bleeding site was opened, and then the cesarean scar was wedge resected and stitched interruptedly with 1-0 absorbable sutures. The postoperative recovery was uneventful. It would seem that the worldwide use of cesarean section delivery may contribute to the risk of gynecologic disturbances including some unrecognized and complex conditions as seen in this case. © 2015 AAGL.

Zhang Z.,Jinhua Municipal Central Hospital | Pan L.,Jinhua Municipal Central Hospital | Ni H.,Jinhua Municipal Central Hospital
General Hospital Psychiatry | Year: 2013

Context: Delirium is prevalent in the intensive care unit (ICU) and has been associated with negative clinical outcomes. However, a quantitative and systematic assessment of published studies has not been conducted. Objective: Meta-analysis of clinical observational studies was performed to investigate the association between delirium and clinical outcomes. Data sources and study selection: Relevant studies were identified by investigators from databases including Medline, Embase, OVID and EBSCO from inception to May 2012. Studies that reported the association of delirium with clinical outcomes in critical care setting were included. Data extraction: Data were extracted independently by reviewers and summary effects were obtained using random effects model. Data synthesis: Of the 16 studies included, 14 studies involving 5891 patients reported data on mortality, and delirious patients had higher mortality rate than non-delirious patients (odds ratio [OR]: 3.22; 95% confidence interval [CI]: 2.30-4.52). Delirious patients had higher rate of complications (OR: 6.5; 95% CI: 2.7-15.6), and were more likely to be discharged to skilled placement (OR: 2.59; 95% CI: 1.59-4.21). Furthermore, patients with delirium had longer length of stay in both ICU (weighted mean difference [WMD]: 7.32 days; 95% CI: 4.63-10.01) and hospital (WMD: 6.53 days; 95% CI: 3.03-10.03), and they spent more time on mechanical ventilation (WMD: 7.22 days; 95% CI: 5.15-9.29). Conclusion: Delirium in critically ill patients is associated with higher mortality rate, more complications, longer duration of mechanical ventilation, and longer length of stay in ICU and hospital. © 2013 Elsevier Inc.

Loading Jinhua Municipal central hospital collaborators
Loading Jinhua Municipal central hospital collaborators