ObjectiveTo evaluate the efficacy of myomectomy via transumbilical laparoendompic single-site surgery (TU-LESS) and traditional multiport laparoscopy.MethodsThe study was conducted at Chengdu Western Hospital from June 2019 to June 2020. Fifty patients underwent TU-LESS myomectomy (TU-LESS group), while another 50 patients underwent traditional multiport laparoscopic myomectmy (multiport laparoscopy group). The conditions of operation, extra analgetic usage, VAS grade, and patients’ satisfaction degree were compared between two groups.ResultsPatients in both groups had similar age, BMI, fibroma volume, operative time, expelling gas day, blood loss, complication rate, and hospitalized costs (P>0.05). Compared with traditional multiport laparoscopy, the TU-LESS group resulted in significantly shorter hospitalization day, lower VAS score of the 1st/3nd/7th days after surgery, less use of analgetic after surgery, and higher satisfaction degree.ConclusionsTU-LESS is safe and feasible for myomectomy, and it is associated with less pain, shorter hospitalization day, and higher satisfaction degree.
ObjectiveTo compare the clinical efficacy of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in the treatment of patients with carotid artery stenosis, and to provide a more abundant evidence-based medicine for the treatment of CEA and CAS in patients with carotid artery stenosis. MethodsForty patients with carotid artery stenosis were randomly divided into CEA group and CAS group based on the operative indication. Patients in CEA group were given carotid endarterectomy treatment and those in CAS group were given carotid artery stenting treatment. Then clinical efficacy of the two groups were observed and compared. ResultsIn terms of the occurring rate of perioperative complications, cardiovascular events in 3 months after operation, and some major end events such as stroke, death and so on, the comparative difference between the two groups was of no statistical significance (P > 0.05). Through the followed-up visits of 12 months, the comparative difference between the two groups was also of no statistical significance (P > 0.05) in terms of the occurring rate of carotid artery restenosis and disabling or fatal stroke. ConclusionsFor patients with severe extracranial carotid stenosis under indication of operation treatment, carotid endarterectomy and carotid artery stenting are of equivalent clinical efficacy, and both of them are of high security, although further study with large-amount and evidence-based medical data in long term from multiple centers is still in need.
Objective To study clinical efficacy of irreversible electroporation in the treatment of advanced hepatic carcinoma. Methods Between July 2015 and September 2015, 8 patients with advanced hepatic carcinoma (10 tumors) were treated by ultrasound-guided irreversible electroporation, using pertacuneous, laparoscope or open surgery in the Rockets Army General Hospital of PLA. Prospectively collected and summarized the clinical data. Finally, analyzed the therapeutic effect of irreversible electroporation. Results Compared with before treatment, the quality of life score significantly increased 〔(37.75±4.65) scores vs. (22.25±2.87) scores, P=0.000〕 in 3 months after treatment of irreversible electroporation, but value of serum total bilirubin (56.37 mmol/L vs. 150.40 mmol/L, P=0.046), direct bilirubin (58.69 mmol/L vs. 71.60 mmol/L, P=0.012), alanine aminotransferase 〔(52.63±12.14) U/mL vs. (87.28±27.94) U/mL, P=0.003〕, asperate aminotransferase 〔(48.45±13.75) U/mL vs. (74.40±21.09) U/mL, P=0.000〕, and alpha fetoprotein (82.10 ng/mL vs. 159.20 ng/mL, P=0.042) significantly decreased. One patient suffered from persistent upper abdominal pain after irreversible electroporation, but no serious complications, such as infection, biliary fistula, hemorrhage, and liver or kidney failure occurred in all 8 patients. Abdominal enhanced CT scanning or MRI in 3 months after irreversible electroporation showed complete ablation in 7 patients and incomplete ablation with some residual in 1 patient. Eight patients were followed up for 3-5 months 〔an average of (4.0±0.9) months〕. During follow-up period, all patients had been alive with 1 case of recurrence. Conclusion The effect of ultrasound-guided irreversible electroporation in the treatment of advanced hepatic carcinoma is remarkable, and it may deserve clinical application in consideration of its safety and efficacy.
Objectives To investigate the clinical efficacy of health education intervention on chronic gastritis nursing. Methods A total of 142 patients with chronic gastritis in our hospital were recruited from February 2016 to June 2017. All patients were randomly assigned into two groups. The control group received conventional therapy and routine nursing, whereas the case group was offered with extra health education based on control group. Then related disease knowledge, nursing efficiency, nursing satisfaction, and nursing quality were compared. Results A total of 71 patients were in the case group, while 71 patients in the control group. Compared with the control group, the case group achieved better related disease knowledge, nursing satisfaction, total nursing efficiency, psychological status, sleep quality, exercise training, and daily diet (all P value<0.05). Conclusions Health education intervention not only can enhance disease knowledge of patients with chronic gastritis but also improve nursing quality, clinical effects and nursing satisfaction. Thus, it is worthy of further popularization in clinics.
Objective To analyze the substitution mechanism of surrogate endpoints for traditional Chinese medicine (TCM) clinical efficacy evaluation of chronic heart failure (CHF). Methods To obtain data from the occurrence of surrogate endpoints and cardiogenic death of patients with CHF in 7 hospitals. The causal relationship between surrogate endpoints and cardiogenic mortality was inferred by the Bayesian network model, and the interaction among surrogate endpoints was analyzed by non-conditional logistic regression model. Results A total of 2 961 patients with CHF were included. The results of Bayesian network causal inference showed that cardiogenic mortality had a causal relationship with the surrogate endpoints including NYHA classification (P=0.46), amino-terminal pro-B-type natriuretic peptide (NT-proBNP) (P=0.24), left ventricular ejaculation fraction (LVEF) (P=0.19), and hemoglobin (HB) (P=0.11); non-conditional logistic regression analysis showed that NYHA classification had interaction with NT-proBNP, LVEF, and HB prior to and after adjusting confounders. Conclusions The substitution capability of surrogate endpoints for TCM clinical efficacy evaluation of CHF for cardiogenic mortality are NYHA classification, NT-proBNP, LVEF, and HB in turn, and there is a multiplicative interaction between the main surrogate endpoint NYHA classification and the secondary surrogate endpoints including NT-proBNP, LVEF, and HB, suggesting that when the two surrogate endpoints with interaction exist at the same time, it can enhance the substitution capability of surrogate endpoints for cardiogenic mortality.
ObjectiveTo investigate the clinical efficacy of low molecular weight heparin on community-acquired pneumonia (CAP). MethodsA total of 78 patients with CAP admitted to hospital between January 2013 and March 2015 were randomly assigned into a conventional treatment group and a heparin treatment group. Both groups received anti-infection and symptomatic treatment, and the patients in heparin treatment group additionally received low molecular weight heparin by abdominal subcutaneous injection once daily for a course with seven days. The age, sex and severity of the disease were recorded. White blood cell (WBC) count and the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured on and during admission. ResultsThe baseline information including age and sex, severity of illness, CRP, ESR and WBC counts on admission and the first treatment day had no difference between two groups (P > 0.05). CRP and ESR on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significantly more decreased than those in the conventional treatment group (P < 0.05). For the moderate and severe CAP patients, the level of CRP on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significant lower than those in the conventional treatment group (P < 0.05). ConclusionCombination therapy of low molecular weight heparin may improve the clinical efficacy of CAP.
Evidence-based medicine advocates to support clinical decision-making with the best evidence, which is useful to objectively evaluate the clinical efficacy of traditional Chinese medicine and optimize clinical diagnosis and treatment. However, significant individualized characteristics identified from syndrome differentiation and treatment are incompatible with evidence-based clinical decision-making, which highlights population-level evidence, to some extent. In recent years, a number of new methods and technologies have been introduced into individualized clinical efficacy evaluation research of traditional Chinese medicine to assist managing and processing complex and multivariate information. These methods and technologies share similarities with evidence-based medicine, and are expected to link the clinical practice of traditional Chinese medicine with evidence-based clinical decision-making. They will guide the development of evidence-based clinical decision-making in traditional Chinese medicine.
ObjectiveTo observe the therapeutic effect of the Tizanidine hydroehloride combined with non-steroidal anti-inflammatory drugs (NSAIDs) on fibromyalgia syndrome. MethodsA total of 166 patients collected from August 2011 to January 2013 were randomly divided into control group and treatment group (with 83 cases in each group), the NSAIDs was used for control group, and for the other group, the Tizanidine hydroehloride combined with NSAIDs was used. The patients in two groups were continuously treated for 2 weeks. And the first and second week after treatment, the psychological evaluation,visual analogue pain, activities of daily living were detected. During the treatment period, the average follow-up duration was 3 months. ResultsThe clinical efficacy was better after treatment in both of the two groups. The clinical efficacy was more significant in treatment group than that in the control group, and the occurrence of gastrointestinal discomfort were less in the treatment group than that in the control group. ConclusionTizanidine hydroehloride combined with NSAIDs is effective on fibromyalgia syndrome. And the Tizanidine hydroehloride can protect the gastrointestine from being injured.
ObjectiveTo observe the clinical effect of unilateral puncture percutaneous kyphoplasty (PKP) through transverse process-pedicle approach (TPA) for the treatment of lumbar osteoporotic vertebral fractures (OVF).MethodsFrom January 2014 to June 2019, a total of 220 OVF patients (321 fractured vertebral bodies) were enrolled, and PKP was performed by unilateral TPA puncture. The distribution of bone cement in vertebral body exceeding the midline of vertebral body was defined as the success of puncture, and the success rates of puncture of different vertebral bodies were recorded. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), anterior and middle heights of the vertebral body, and the local Cobb angle were compared between three time points namely before operation, 1 day after operation, and 6 months after operation. Surgery-related complications were recorded.ResultsThe 220 patients included 57 males and 163 females, with a mean age of (70.3±6.5) years, a mean course of disease of (18.7±17.7) d, and a mean bone mineral density of −3.3±0.6. The success rate of puncture from L1 to L5 was 81.7% (85/104), 95.2% (80/84), 100.0% (69/69), 97.6% (41/42), and 72.7% (16/22), respectively. The mean volume of bone cement injected into the vertebral bodies was (5.8±0.9) mL. Two patients were followed up for less than 6 months because of death or loss to follow-up, and the other 218 patients were followed up for 6-57 months, with an average of (19.6±8.7) months. Before surgery, 1 day after surgery, and 6 months after surgery, the median (lower quartile, upper quartile) of VAS scores was 6 (6, 8), 1 (1, 2), and 2 (1, 2), respectively, with statistically significant differences in all the two-two comparisons (P<0.017). At the three time points, the median (lower quartile, upper quartile) of ODI was 61% (54%, 66%), 26% (22%, 30%), and 25% (24%, 31%), respectively, the mean height of anterior vertebral body was (18.3±2.8), (22.6±3.0), and (22.6±3.1) mm, respectively, the mean height of middle vertebral body was (17.8±2.2), (22.9±2.8), and (22.9±2.7) mm, respectively, the mean local Cobb angle was (19.9±2.6), (14.4±2.8), (14.4±2.8)°, respectively, and the values at 1 day and 6 months after surgery all differed from those before surgery (P<0.017). A total of 32 cases (42 vertebrae) had bone cement leakage, of whom 4 cases had related symptoms. There were 32 re-fractures of the vertebral bodies, including 18 adjacent vertebral body fractures, with an incidence rate of 5.6%. There were 3 vertebral infections after operation, the incidence was 0.9%.ConclusionPatients with OVF of the lumbar spine undergoing unilateral TPA puncture for PKP surgery have a high success rate, definite clinical effect, and satisfactory correction of local deformities.
ObjectiveTo investigate the effect of fasttrack (FT) and traditional care (TC) on patients with rectal cancer underwent different surgical strategies in perioperative period. MethodsThe clinical data of 285 patients with rectal cancer from January 2009 to January 2010 in this hospital were retrospectively analyzed. These patients underwent high anterior resection (HAR) or lower/super lower anterior resection (LAR) under FT and TC were divided into four groups: FT+HAR (n=39), FT+LAR (n=17), TC+HAR (n=151), and TC+LAR (n=78), and intraoperative conditions and postoperative rehabilitation were analyzed. ResultsThe baselines characteristics of four groups were basically identical (Pgt;0.05). ①The operative time and blood loss of patients in four groups were not statistically significant (Pgt;0.05). ②Anastomotic leakage occurred in three cases, wound infection in 13 cases, and intestinal obstruction in four cases after operation, and the difference was not significant in four groups (Pgt;0.05). ③The time of first defecation and first flatus of four groups were not statistically significant (Pgt;0.05), but there were significant differences in the time with drainage tube, nasogastric tube, and catheter tube, the time of first intake and first ambulation, and length of stay among four groups (Plt;0.05). Compared with TC+HAR and TC+LAR group, the time with drainage tube, nasogastric tube, and catheter tube, and the time of first intake and first ambulation of patients were shorter in FT+HAR and FT+LAR group, and the length of stay of patients in FT+LAR group was shorter than that in TC+HAR group and TC+LAR group (Plt;0.05). ConclusionsFT can promote postoperative rehabilitation of rectal cancer patients underwent different surgical strategies, but which does not demonstrate the superiority of reducing postoperative complications.