简介：AbstractThe contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery. Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care. Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients. The many areas of potential variability in the pre, intra and post-operative timeline of pituitary surgery are readily identifiable. Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.

简介：AbstractPancreatic surgery contains several major procedures of pancreatectomy. Surgical trauma, severe complications and preoperative nutritional disorders will affect postoperative recovery and clinical outcomes of patients. Perioperative whole-course nutrition management focus on rational nutritional care from admission to discharge even post-hospital follow-up, including preoperative nutritional screening, perioperative nutrition assessment and intervention. The whole-course strategy has been validated in some other fields by RCTs and is also seemed to be suitable for pancreatic surgery. However, few high-grade evidences have been published and controversy still exists. This review aims to reflect the current situation, consensus and controversy of perioperative nutrition management in pancreatic surgery, expecting to provide necessary guidance for clinical research and practice.

简介：AbstractSince December 2019, a pneumonia caused by a new coronavirus, i.e. COVID-19 occurred in Wuhan, Hubei Province, China. Although the epidemic in China has been bought under control, the global COVID-19 situation is still grim. Severe traumatic brain injury (TBI), as one of critical conditions in the department of neurosurgery, requires an early and effective treatment, especially surgery. There were currently no reliable guidelines on how to perform perioperative protection in TBI patients with suspected or confirmed coronavirus infection. According to the corresponding treatment regulations and guidelines issued by the authorities, we summarized the management strategy of TBI patients in perioperative period during the COVID-19 outbreak based on medical and nursing practice, in order to provide a reference for clinicians.

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简介：AbstractObjective:Management of postoperative pain after head and neck cancer surgery is a complex issue, requiring a careful balance of analgesic properties and side effects. The objective of this review is to discuss the efficacy and safety of multimodal analgesia (MMA) for these patients.Methods:Pubmed, Cochrane, Embase, Scopus, and clinicaltrials.gov were systematically searched for all comparative studies of patients receiving MMA (nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, anticonvulsants, local anesthetics, and corticosteroids) for head and neck cancer surgeries. The primary outcome was additional postoperative opioid usage, and secondary outcomes included subjective pain scores, complications, adverse effects, and 30-day outcomes.Results:A total of five studies representing 592 patients (MMA, n = 275; non-MMA, n = 317) met inclusion criteria. The most commonly used agents were gabapentin, NSAIDs, and acetaminophen (n = 221), NSAIDs (n = 221), followed by corticosteroids (n = 35), dextromethorphan (n = 40), and local nerve block (n= 19). Four studies described a significant decrease in overall postoperative narcotic usage with two studies reporting a significant decrease in hospital time. Subjective pain scores widely varied with two studies reporting reduced pain at postoperative day 3. There were no differences in surgical outcomes, medical complications, adverse effects, or 30-day mortality and readmission rates.Conclusion:MMA is an increasingly popular strategy that may reduce dependence on opioids for the treatment of postoperative pain. A variety of regimens and protocols are available for providers to utilize in the appropriate head and neck cancer patient.

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简介：Cimetidine(CIM)isahistaminetype2receptorantagonistwidelyusedtotreatpepticulcers.Italsohasimportanteffectsontheimmunesystem.TheadministrationofCIMhasbeenfoundtopreserve,tosomedegree,patient’sperioperativeimmunecapability.']However,whethertheuseofCIMca...

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简介：摘要：经导管主动脉瓣膜置换术具有创伤性小、术后并发症和致死率较低的优势，因此该手术具有极高的治疗安全性，成为了治疗复杂高危的主动脉瓣狭窄患者的主要治疗手段，根据相关学者的研究，为复杂高危主动脉瓣狭窄患者实施经导管主动脉瓣膜置换术治疗后的情况进行随访调查，证实了该手术用于治疗的安全性和与有效性。为患者实施手术治疗的时候，需要帮助患者完善各项检查，通过多学科协同评估患者的机体状态，制定合理的治疗方案，并且为患者实施个性化的护理方案，改善患者的心肾功能。护理人员需要充分了解经导管主动脉瓣膜置换术的流程、注意事项和潜在的危险，检测患者的病情，为患者术后实施呼吸支持，维持体循环等手段，降低并发症发病率。

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简介：人类有七种消极情绪：恐惧、仇恨、愤怒、贪婪、嫉妒、报复、迷信。七种积极情绪：爱、性、希望、信心、同情、乐观、忠诚。在生活、工作中，有许多事都受到感情的影响。我们的感情可为我们带来伟大的成就，也可能使我们失败。敌意和愤怒是致命的心态，发怒是典型的慢性自杀。如果你的心绪欠宽容，那么学会抑制愤怒应视为当务之急。

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简介：十二指肠的损伤由于增加的汽车事故和强烈事件经常越来越不平常却现在看见。十二指肠的损伤的管理能是复杂的，特别当对pancreatic-duodenal-biliary建筑群的巨大的损害同时发生时。甚至病人及时收到手术，多重手术后的复杂并发症和高死亡是普通的。更好知道并且设法十二指肠的损伤，我们由十二指肠的损伤，治疗，诊断和腹部的关键词在PubMed寻找了最近的相关文学。它证明因为诊断和管理是复杂的，死亡高，十二指肠的损伤应该及时并且机智地被对待。并且新技术的申请能帮助改进管理。在这评论，我们讨论了十二指肠的损伤的发生，诊断，管理，和复杂并发症以及死亡。

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简介：AbstractHypertension in pregnancy is currently defined as a systolic blood pressure (BP) of 140 mmHg or more, or a diastolic BP of 90 mmHg or more. This level of BP warrants antihypertensive therapy. Treating to a target BP of 135/85 mmHg halves the risk of severe hypertension that is itself associated with adverse maternal and perinatal outcomes, similar in magnitude to preeclampsia. While based on the results of the Control of Hypertension in Pregnancy Study (CHIPS) trial, this finding is consistent with all antihypertensive trials to date. Also, in the CHIPS trial, "tight" BP control also halved the risk of progression to thrombocytopenia and elevated liver enzymes for the mother, without adverse effects for the fetus or newborn. This was true regardless of the gestational age at which BP control was instituted. While methyldopa, labetalol, and nifedipine are the most commonly-recommended oral antihypertensives, it is not clear that one antihypertensive agent has advantages over the others for treatment of non-severe hypertension in pregnancy. No antihypertensives, including renin-angiotensin-aldosterone system (RAAS) inhibitors, have been shown to be teratogenic, although there may be an increase in malformations associated with the underlying condition of chronic hypertension. Atenolol and RAAS inhibitors should not be used once pregnancy is diagnosed, based on fetotoxicity. At present, BP treatment targets used in clinic are the same as those used at home as the differences are quite variable among hypertensive women. For treatment of acute severe hypertension, the most commonly-recommended antihypertensives are oral nifedipine, IV labetalol, and IV hydralazine, although oral agents have also been shown to be effective in the majority of women; while concerns raised about IV hydralazine-induced maternal hypotension and its consequences have not been confirmed, this medication may be an inferior antihypertensive to oral nifedipine. While treatment recommendations are based on evidence, women should be engaged in decision-making, as their values may alter target BP and antihypertensive choice. Future work will clarify the optimal target BP based on home BP measurements; whether BP targets should be lowered further if the definition of hypertension is based on a lower BP; which, if any, antihypertensive medication for non-severe hypertension is better with regards to maternal and perinatal outcomes; and whether factors beyond BP level (such as variability, race, and other physiological variables) should inform antihypertensive therapy in pregnancy.

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