Chronic obstructive pulmonary disease (COPD) is one of the common chronic airway disorders, which accounts for the third to fourth cause of death worldwide. Recently, the focuses of researches are on the multi-factorial risks for development of COPD, mechanisms related to COPD development, early detection and early intervention of COPD, individualized use of long-term maintenance medications as well as phenotypes of acute exacerbation of COPD and their corresponding management. There are huge amount of COPD patients with variety of risk factors or different phenotypes in China, which makes it possible to establish a network for cohort study or real life registration study of COPD. The results will provide new information on the characteristics of COPD in China. Individualized treatment could be recommended according to the phenotypes or endotypes information. All these new findings or progresses could provide impetus for improvement of the ability of research and clinical management of COPD to the worldwide top level.
ObjectiveTo explore the application value of multidisciplinary collaborative team (MDT) model in retroperitoneal tumors involving large vessels.MethodsThree cases of retroperitoneal tumors involving great vessels admitted to Xiang’an Hospital of Xiamen University in 2019 were retrospectively analyzed. With the support of 3D visual reconstruction and virtual reality (VR) technology, we performed MDT discussion and three cases received treatment of surgery, intervention, and targeted therapy.ResultsCase 1 was discussed by MDT and concluded that, based on CT examination, 3D reconstruction, and VR virtual image results, the tumor on the right side was determined to be completely resectable. The left tumor was judged to be unresectable, and the proposed treatment plan was right metastatic tumor resection + left metastatic tumor radiofrequency ablation. After surgery case 1 had been followed up for 6 months. The symptoms of diarrhea were significantly improved. CT reexamination showed that liver lesions and left retroperitoneal lesions were the same size and the condition was stable. After discussion by MDT, radiofrequency ablation around the tumor was proposed for case 2. This case was followed up for 3 months after surgery, and CT reexamination showed no new lesion in retroperitoneum. After MDT discussion, we concluded that arteriovenous fistula of case 3 had no indications for surgery, and proposed interventional combined with targeted therapy. After treatment, the tumor was found to be smaller after reexamination in 8 months than before treatment, and the efficacy was evaluated as partial remission. The follow-up was continued.ConclusionThe future development trend of retroperitoneal tumor therapy involving great vessels is to evaluate each patient’s condition under the MDT mode by using 3D visual reconstruction and VR technology, and to formulate the individualized treatment plan of operation combined with other treatments.
ObjectiveTo explore the clinical phenotype of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) by cluster analysis and provide a basis for individualized treatment.MethodsA total of 515 patients with acute exacerbation of COPD admitted to this department from January 2014 to December 2016 were enrolled. The age, duration, smoking index, number of hospitalizations in the past 1 year, hospitalization days, treatment costs and other information were collected for cluster analysis.ResultsThe patients were divided into three categories of phenotype: " mild-glucocorticoid resistance-antibiotic dependent”," mild-glucocorticoid sensitive”, and " serious complication”. The patients with the first two phenotypes had a milder condition and lower hospitalization costs. There were differences in the time and cumulative dose of glucocorticoids in different pathways, antibiotic use time and usage rate. The third phenotype was the most serious, with the highest cost of hospitalization, and may merge or co-exist with other diseases such as cardiovascular disease and digestive tract disease.ConclusionCluster analysis may identify different phenotypes of acute exacerbation of COPD to provide a reference for clinical individualized treatment.
Objective To investigate the effectiveness of individual surgery for chronic Achilles tendon rupture. Methods A retrospective analysis was made on the clinical data of 25 patients (26 Achilles tendons) with chronic Achilles tendon rupture between September 2009 and March 2016, including 22 males and 3 females with a mean age of 38 years (range,18-59 years). The median disease duration was 12 weeks (range, 4 weeks to 12 years). The repairing method depended on the defect size, injury site, and tissue condition of the involved Achilles tendon: 9 Achilles tendons were repaired by end-to-end anastomosis, 8 by a gastrocnemius turndown flap, and 9 by auto free tendon (4 ipsilateral hamstring tendon and 5 ipsilateral 2/3 peroneus longus tendon). The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score, heel lifting of the affected leg, active ankle range of motion (plantar flexion and dorsiflexion), maximum calf circumference, and complications were applied to assess the effectiveness. Results Hypersensitivity occurred in 1 incision, and stage I healing was obtained in the other incisions. No complication of re-rupture, infection, nerve injury, or deep venous thrombosis occurred. All the patients were followed up 8-85 months (mean, 34 months). The AOFAS ankle-hind foot score was significantly improved to 95.81±5.34 at last follow-up from preoperative 50.54±5.52 (t=–34.844,P=0.000); the excellent and good rate was 100% (excellent in 21 cases and good in 4 cases). The active dorsiflexion of the operated side [(13.9±2.4)°] was significantly lower than that of normal side [(16.7±2.0)°] (t=–9.099,P=0.000), but the active plantar flexion showed no significant difference between affected side [(39.8± 3.2)°] and normal side [(40.6±2.6°)] (t=–1.917,P=0.068). The maximum calf circumference of the operated side [(379.4±18.8) mm] was significantly lower than that of normal side [(387.1±16.6) cm] (t=–5.053,P=0.000). The other patients could finish heel lifting of the affected leg without limitation except for 1 patient. All patients returned to normal work and activity, and 12 patients returned to normal sports. Conclusion Individual surgery depending on the defect, injury site, and tissue condition of the involved Achilles tendon can repair all kinds of chronic Achilles tendon rupture with a low rate of complications.
ObjectiveTo explore the effectiveness of transplantation of engraved autologous costal cartilage for individualized surgical management in secondary rhinoplasty for cleft lip. MethodsBetween September 2009 and January 2014, 350 patients with secondary nasal deformity of cleft lip were treated, including 160 males and 190 females with a mean age of 18.2 years (range, 16-56 years). Nasal deformity was caused by unilateral cleft lip in 200 cases and by bilateral cleft lip in 150 cases. The interval of lip repair and nasal deformity correction was 2-50 years (mean, 12 years). About a 2-6 cm cartilage was harvested from the 6th or 7th costal cartilage, and was engraved to the shape of "ge" in Chinese. The upper part was strengthened on both sides of the alar cartilage; the lower part was fastened to columella and nasal septum cartilages. The rest of cartilages was diced into 0.1 mm×0.1 mm×0.1 mm cubes. The columella incision was designed to "Z"-plasty, and was stretched to the nasion along alar edge. The engraved autologous costal cartilage was transplanted and fixed to the collapse of nostril. The cartilage cube was transplanted and filled into the collapse of nasal root to achieve the aesthetic effect of nasal augmentation. The effectiveness was evaluated according to the grade of secondary rhinoplasty for cleft lip by ZHANG Li et al. at 1, 6, and 12 months after operation. ResultsAll incisions were primary healing. All patients were followed up 1-12 months (mean, 6 months). After rhinoplasty, the collapse of nostrils was lifted, and the shape and height of collapse of nostrils were symmetrical to normal side. The deflection of columella nasi was corrected. A beautiful shape of nose was achieved. The excellent and good rates were 98.6% at 1 month, 97.4% at 6 months, and 97.1% at 12 months after operation, showing no significant difference (χ2=0.545, P=0.761). ConclusionThe technique of transplantation of engraved autologous costal cartilage for individualized surgical management in secondary rhinoplasty for cleft lip can achieve excellent surgery effect.
Objective To evaluate the importance of "one-stop" hybrid operating room in the individualized treatment of aortic pathology. Method We retrospectively analyzed the clinical data of 247 patients of aortic pathology who were operated in the hybrid operating room in our hospital from January 2013 through December 2014. There were 193 males and 54 females at age of 24-83(54±12) years. Results Thoracic or abdominal endovascular aortic repair (TEVAR/EVAR) was applied in 132 patients, including 122 simple patients and 10 complexes. Fenestrated TEVAR was applied in 61 patients. Hybrid operation was done in 54 patients. Perioperative death occurred in 9 patients (3.6%). Perioperative complication rate was 11.7% (29/247) . The patients were followed up for one year. During follow-up, five patients were dead. The one-year survival rate was 98.0% (242/247) . Conclusions "One-stop" individualized treatment of aortic pathology shows its advantage, yet long-term result still needs to be followed up.
ObjectiveTo review the imaging evaluation, treatment progress, and controversy related to developmental dysplasia of the hip (DDH) in adolescents and adults. Methods The domestic and abroad hot issues related to adolescents and adults with DDH in recent years, including new imaging techniques for assessing cartilage, controversies over the diagnosis and treatment of borderline DDH (BDDH), and the improvement and prospect of peracetabular osteotomy (PAO) were summarized and analyzed. ResultsDDH is one of the main factors leading to hip osteoarthritis. As the understanding of the pathological changes of DDH continues to deepen, the use of delayed gadolinium-enhanced MRI of cartilage can further evaluate the progress of osteoarthritis and predict the prognosis after hip preservation. There are still controversies about the diagnosis and treatment of BDDH. At the same time, PAO technology and concepts are still being improved. ConclusionCartilage injury and bony structure determine the choice of surgical methods and postoperative prognosis of hip preservation surgery. The hip preservation of adolescent and adult DDH patients will move towards the goal of individualization and accuracy.
ObjectiveTo summarize the research progress of patient-derived organoid (PDO) and patient-derived xenograft (PDX) models in preclinical drug screening for gastric cancer, aiming to provide a new perspective for precise drug screening and promote the application of personalized medicine and precision medicine for gastric cancer. MethodA literature review was conducted on the use of PDO and PDX models in the basic research and preclinical drug screening for gastric cancer. ResultsThe PDO and PDX models of gastric cancer exhibited a higher tumor biological simulation capability and a relatively accurate preclinical drug response prediction. However, they each have some certain limitations. The advent of organoid models based on xenografting, which combines the advantages of both, is expected to compensate for their respective shortcomings. These models can better reflect the heterogeneity of patients’ tumors and have unique advantages in the evaluation of new targeted drugs for specific molecular targets in gastric cancer, such as epidermal growth factor receptor. They show a certain correlation with the actual clinical response of patients, paving a new way for the development of new drugs, the study of drug action and resistance mechanisms, and personalized therapy. ConclusionPDO and PDX models, as a highly promising research platform, show a great potential in the screening of anti-tumor drugs and the development of personalized medical strategies.