Objective To evaluate the efficacy and safety of whole lung lavage in the treatment of pulmonary alveolar proteinosis ( PAP) .Methods Twelve patients who were diagnosed as PAP from September 2008 to October 2011 in Hunan Occupational Disease Hospital were recruited in the study. The changes of dyspnea symptom, lung-function, arterial blood gas, and chest image were compared before and after whole lung lavage treatment. Meanwhile, the safety of lung lavage was evaluated. Results All patients were relieved from dyspnea. The lung function, hypoxia, hyperventilation, and chest image were all obviously improved. The vital signs in the process of lung lavage were stable without serious complications. Conclusion Whole lung lavage is an effective and safe treatment for PAP.
ObjectiveTo explore the security and advantages of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for occupancy lesions in pancreatic body and tail. MethodsA total of 97 patients with occupancy lesions in pancreatic body and tail who underwent laparoscopic distal pancreatectomy in our hospital from June 2010 to August 2014 were collected retrospectively, and were divided into LSPDP group (n=60) and laparoscopic distal pancreatectomy with splenectomy (LDPS) group (n=37) according to the surgery, clinical effect was compared between the 2 groups. ResultsThe operations got well in all patients, no one died during perioperative period. The operation time was shorter in LSPDP group than that of LDPS group[(190.83±66.39) min vs. (224.46±83.23) min, P=0.030], but there was no significant difference between LSPDP group and LDPS group in the blood loss[45.35 mL vs. 54.92 mL], hospital stay[(8.38±4.06) d vs. (9.76±4.54) d], incidence of total postoperative complication[23.33% (14/60) vs. 13.51% (5/37)], and degree of postoperative complication (P>0.050). There were 86 patients were followed up for 3-54 months, with the median time of 18 months. For patients with tumor, no one suffered from recurrence, metastasis, and death during the follow-up period, and other patients with benign diseases had an excellent prognosis. ConclusionFor occupancy lesions in pancreatic body and tail, LSPDP is feasible and safe.
ObjectiveUnder the principle of promoting the reform of TCM payment methods, analyzing the difference in efficacy and cost of treatment using Western medicine or traditional Chinese medicine, and providing health economics basis for the reform of payment methods for advantageous diseases of TCM. MethodsData from the first page of medical records of 4 Chinese hospitals and 4 western hospitals of the same level were collected from 2020 to 2021 in typical areas, focusing on four typical TCM advantageous diseases that were consistent with diabetes, cervical spondylosis, arthralgia syndrome in the lumbar area or pelvic inflammation, and a total of 14 958 cases were included through propensity score matching. Under the assumption of same disease, same effect and same price, the age, bed days, total cost, discharge condition and reoperation condition of the same disease in 90 days were analyzed and compared between the two groups. ResultsIn terms of outcomes, the experimental group showed significantly better discharge outcomes compared with the control group for the four diseases. In terms of cost, the control group had higher total costs for arthralgia syndrome in the lumbar area and cervical spondylosis, while the control group had lower total costs for diabetes. After controlling for treatment effects, the control group had higher costs for cervical spondylosis and pelvic inflammatory disease compared to the experimental group, while the control group had lower costs for diabetes and arthralgia syndrome in the lumbar area compared to the experimental group. ConclusionThe experimental group shows better treatment effectiveness for the four TCM-dominant diseases. The control group has higher costs for cervical spondylosis and pelvic inflammatory disease when discharge outcomes are limited, while the control group has lower costs for diabetes and arthralgia syndrome in the lumbar area. This highlights the necessity of reforming the payment methods for TCM-dominant diseases. Additionally, the development of TCM-dominant diseases should focus on addressing the high demand for elderly chronic diseases in TCM.
Objective To analyze and compare the clinical efficacy and advantage between two treatments methods for chronic anal fissure. Methods Divided 96 patients with chronic anal fissure into two groups based on the odd and even numbers of treatment order: 48 patients in study group received sequential anal dilation and microwave treatment, and 48 patients in control group received posterior internal sphincterotomy. The blood loss in operation, wound healing time, wound infection rate, anal infection rate, anal control, postoperative defecation function, anal stenosis rate, and the recurrence rate between the two groups were compared and analyzed. Results Blood loss and wound healing time were less in study group than those in control group (Plt;0.01). Anal control was better in study group than that in control group (Plt;0.05). There were no occurrences of wound infection or anal infection, and the defecation function was improved in both of the two groups. There was no recurrence after one year follow-up in both of the two groups. Anal stenosis rate in study group is lower than that in control group (Plt;0.01). Conclusion The technique of sequential anal dilation and microwave treatment can reduce pain, and is simple, effective, and worthy of promotion.
ObjectiveTo explore the relationship of topoisomerase typeⅡA (TOP2A)to human epidermal growth factor receptor 2(HER2/neu), and the therapeutic prediction of TOP2A in clinical chemotherapy for breast cancer. MethodThe Cochrane, Medline, Embase, PubMed, CNKI, and WANFANG data were retrieved to get the related literatures about TOP2A and the effect of anthracycline-based drugs. ResultsThe TOP2A gene and HER2 gene were all located in 17q21, the TOP2A gene was a downstream gene of the HER2 gene. There was some relationship of the HER2 to TOP2A gene abnormality. There was some controversy about HER2 and TOP2A on anthracycline regimens reaction. It was generally accepted that the status of TOP2A gene for predicting the effect of patients with anthracycline regimens might be more precise. There was inconsistency between the gene amplification and overexpression of TOP2A, which was two different biological behaviors, and which might be the characteristics of different molecular subtypes. In terms of the present study, a plenty of clinical researches could illustrate that TOP2A was an important target of anthracycline. But anthracycline-based drugs could induce the apoptosis of the cell through various mechanisms, so the anthracyclinebased drugs killed tumor cells in breast cancer needed not inhibit TOP2A, might be more complex than previously predicted. ConclusionsTOP2A is an important target of anthracycline. But it seems to be limited only by observing the TOP2A for predicting curative effect of anthracycline-based drugs.
Objective To retrospectively analyze the clinical and imaging features of multi-segmental lumbar intervertebral disc protrusion and its treatment with the limited recessive decompression operation. Methods Twenty two patients (14 males and 8 females, aged 49-68 years) were admitted to hospital from March 1999 to March 2004. They suffered from multisegmental lumbar intervertebral disc protrusion that involved L1S1 and were treated with the limited recessive decompression operation. Results The follow-up for 4-21 months showed that 16 of the patients had an excellent outcome, 5 had a good outcome, and 1 had fair outcome. There were nosuch operative complications as nerve root lesions and putamen lesions. Conclusion The limited recessive decompression operation is one of the available good treatments for multi-segmental lumbar intervertebral disc protrusion. It solves problems of herniation and stenosis and maintains stability ofthe spine.
Objective To evaluate the clinical curative effect of early enteral nutrition （EN） in gastric cancer patients after operation and its safety. Methods One hundred and eighty patients with gastric cancer diagnosed and underwent surgical treatment in gastrointestinal surgery center， West China Hospital from February 2011 to December 2011 were studied prospectively， who were randomly divided into EN group （n=91） and parenteral nutrition （PN） group （n=89）. The nutrition state， rehabilitation， hospital stay， cost of nutrition in hospital， and complications were observed. Results ①According to the postoperative serum nutrition index， there were no significant differences in the prealbumin， hemoglobin， and ratio of albumin to globulin in two groups （P＞0.05）， but the albumin level in the EN group was significantlyhigher than that in the PN group （P=0.047）. ②According to the postoperative rehabilitation index， the first ambulation time （P=0.011）， first intake time （P=0.000）， first nasogastric tube away time （P=0.013）， first drainage tube away time （P=0.021）， and first urinary catheter away time （P=0.002） in the EN group were significantly shorter than those in the PN group. The difference of the first anus exhaust time was not statistically significant in two groups （P=0.083）. ③The cost of nutrition in hospital in the EN group was significantly less than that in the PN group （P=0.017）. The postoperative hospital stay and total complication rate were not significant differences in two groups （P＞0.05）. Conclusion Early postoperative EN is effective， economic， practical， which might be superior to PN.
Objective To compare the outcomes of ranibizumab and conbercept adjunct for pars plana vitrectomy (PPV) in the treatment of proliferative diabetic retinopathy (PDR). MethodsA prospective randomized case-control study. From June 2022 to December 2023, 90 cases (90 eyes) of PDR patients diagnosed through ophthalmic examination at Department of Ophthalmology of Gansu Provincial Hospital were included in the study. All patients underwent the best corrected visual acuity (BCVA), intraocular pressure, B-mode ultrasound, and optical coherence tomography (OCT) examinations. The central macular thickness (CMT) was measured using an OCT instrument. The patients were randomly divided into a intravitreal injection of ranibizumab group (monoclonal-antibody group) and a intravitreal injection of conbercept group (fusion-protein group) using a random number table method, with 45 cases (45 eyes) in each group. Two groups of patients were intravitreal injected with 10 mg/ml ranibizumab or conbercept 0.05 ml, respectively. A standard 23G PPV was performed through the flat part of the ciliary body 3-7 days after intravitreal injection. Relevant examinations were performed using the same equipments and methods as before surgery at postoperative 1 week, 1, 3, 6, and 12 months. The PPV time, intraoperative use of intraocular electrocoagulation, incidence of iatrogenic retinal breaks, and sterile air or silicone oil tamponade rate in the vitreous cavity, the postoperative changes of BCVA and CMT, and incidence of complications were compared between two groups. Independent sample t test was used for inter group comparison. ResultsThe intraoperative utilization rate of intraocular electrocoagulation in the monoclonal-antibody group was higher than that in the fusion-protein group, and the difference was statistically significant (χ2=3.876, P＜0.05). There were no statistically significant differences in the PPV time (t=0.152), intraoperative bleeding rate (χ2=0.800), incidence of iatrogenic retinal breaks (χ2=1.975), and sterile air and silicone oil tamponade rate in the vitreous cavity (χ2=1.607, 1.553) between the two groups (P＞0.05). There were no statistically significant differences in early and late postoperative vitreous hemorrhage (χ2=1.235, 2.355), and re-PPV (χ2=2.355) between two groups (P＞0.05). The BCVA of the fusion-protein group was significantly better than that of the monoclonal-antibody group at postoperative 3 months, and the difference was statistically significant (t=2.428, P＜0.05). The CMT of the fusion-protein group was lower than that in the monoclonal-antibody group at postoperative 1 week, and the difference was statistically significant (t=2.739, P＜0.05). None of the patients experienced endophthalmitis, retinal artery occlusion, or severe cardiovascular events after surgery. ConclusionCompared with intravitreal injection of ranibizumab before PPV, intravitreal injection of conbercept before PPV in PDR patients can shorten the surgical time, reduce intraoperative bleeding rate, lower the rate of electrocoagulation and intraocular tamponade, and incidence of iatrogenic retinal breaks, and improve the visual acuity.
Objective To summarize the experience of the surgical treatment of total anomalous pulmonary venous connection (TAPVC) in 31 cases，so as to elevate the operative effect. Methods The total corrected operation under moderate hypothermic cardiopulmonary bypass were performed in 31 cases with TAPVC. Site of drainage was supracardiac (n=16),cardiac(n=13)and mixed(n=2). Other accompanying congenital cardiac malformations were diagnosed such as atrial septal defect(n=31), patent ductus arteriosus(n=4), pulmonic stenosis(n=1), mitral regurgitation(n=1), tricuspid regurgitation (n=15)，etc. Results No hospital death was observed in the early period of operation (30 d). Complication occurred in 8 cases (25.8%), such as paroxysm of nodal rhythm(n=1), Ⅰ° atrial ventricular block(n=1), frequently atrial premature beats and paroxysm of auricular tachycardia(n=1),pulmonary infection(n=2),atelectasis(n=1), pneumatothorax (n=1), left diaphragmatic paralysis and pulmonary infection with tracheal reintubation (n=1),etc. All of them discharged after active therapy. All of 31 cases was followed up, followup time was 2.8±1.5 years. 30 cases were living (96.7%) and 1 case died of heart failure 8 months after operation. 2 cases had auricular arrhythmia with a bad medical effect. 28 cases(93.3%) had normal heart function and they could work and live normally after discharged. Conclusion Surgical procedure should be based on individual abnormality for TAPVC.Surgeons should take care not only of the stenosis of anastomotic stoma,but also of the arrhythmia after operation.Satisfied correction of the abnormality is important and the curative effect of those cases is approving.
ObjectiveTo preliminarily explore the damage effect of stereo electroencephalogram-guided radiofrequency thermocoagulation after increasing the number of electrodes in the epileptic foci.MethodsEight cases were included from 42 patients requiring SEEG from the Department of Neurosurgery of the Second Hospital of Lanzhou University during June 2017 to Jan. 2019, of which 6 cases were hypothetical epileptogenic foci located in the functional area or deep in the epileptogenic foci that could not be surgically removed, 2 patients who were unwilling to undergo craniotomy; added hypothetical epileptic foci Electrodes, the number of implanted electrodes exceeds the number of electrodes needed to locate the epileptic foci. After radiofrequency thermocoagulation damages the epileptogenic foci, the therapeutic effect is analyzed.ResultsIn 8 patients, the number of implanted electrodes increased from 1 ~ 6, with an average of (4±2.2), and the number of thermosetting points increased by 2 ~ 10, with an average of (7±3.1); follow-up (9±3.2) months, Epilepsy control status: 3 cases of Engel Ⅰ, 3 cases of Engel Ⅱ, 2 cases of Engel Ⅲ; 8 cases of epileptic seizure frequency decreased≥50%. There was a statistically significant difference in the frequency of attacks before and after thermocoagulation (P<0.05).ConclusionsIncreasing the lesion volume of the epileptic foci can obviously improve the efficacy of epilepsy. SEEG-guided radiofrequency thermocoagulation is an effective supplementary method for classical resection.