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Objective@#To investigate the clinical efficacy of modified tracer minimally invasive fixation in robot-assisted pedicle screw placement.@*Methods@#A prospective randomized controlled study was conducted to analyze the clinical data of 41 patients with thoracolumbar fresh fracture at the orthopaedics department of Karamay Central Hospital from July 2017 to December 2017. There were 20 males and 21 females, aged 25-55 years, with an average of 40.6 years. According to AO fracture typing, there were 28 patients with type A and 13 patients with type B. The patients underwent robot-assisted pedicle screw placement. Random number table method was used to divide the patients into the conventional group (20 patients) and modified group (21 patients). The conventional group was treated with conventional tracer fixation, and the modified group modified tracer minimally invasive fixation. A total of 92 pedicle screws were implanted in the conventional group and 96 pedicle screws were implanted in the modified group. The size of wound, wound bleeding, time of fixing the tracer, complications (spinal cord injury and nerve root injury when fixing the tracer), development of the tracer fixator and artifacts were recorded. The accuracy of nail placement was evaluated by 320-slice CT scan and Gertzbein-Robbins criteria.@*Results@#There was no significant difference in age, sex, diagnosis, transverse diameter of pedicle and e angle between the two groups (P>0.05). The wound size, wound bleeding, and time of fixing the tracer in the modified group were (6.00±1.26)mm, (1.38±0.22)ml and (1.42±0.17)minutes, respectively, while those of the conventional group were (40.16±5.71)mm, (11.61±1.15)ml, and (5.12±0.64)minutes respectively (P<0.05). No spinal cord or nerve root injury occurred in either group when the tracer was fixed. In the process of three-dimensional image acquisition and automatic registration, the tracer fixator in the modified group developed with Kirschner needle without artifacts, and the tracer in minimally invasive fixator had good fluoroscopy effect. The modified group included 94 pedicle screws of type A and two of type B according to Gertzbein-Robbins criteria. The conventional group included 89 pedicle screws of type A and three of type B according to Gertzbein-Robbins criteria. There was no significant difference in the screw placement accuracy between the two groups (P>0.05).@*Conclusion@#In the robot-assisted pedicle screw placement, the modified tracer minimally invasive fixation method is safe and less traumatic, with no side effect on the accuracy of pedicle screw placement.
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Objective To summarize CT and MRI features of hyaline vascular type localized Castleman disease(LCD)and analyze the causes of misdiagnosis,to improve the preoperative diagnosis rate.Methods The clinical and imaging data of 7 patients with hyaline vascular type LCD confirmed by operation and pathology were analyzed retrospectively.Results (1)6 cases were misdiagnosed before operation,1 case was misdiagnosed as pancreatic neuroendocrine tumor,1 case as thymoma,1 case as neurogenic tumor,1 case as pheochromocytoma, 1 case as clear cell renal cell carcinoma and 1 case as small mesenteric stromal tumor.(2)1 case was located in the right neck,1 case in the anterior superior mediastinum,1 case in the neck of the pancreas,1 case in the upper part of the left kidney,2 cases in the retroperitoneum and 1 case in the lower abdomen.(3)3 cases were scaned by dynamic enhanced MRI,3 cases were scaned by dynamic enhanced CT, and 1 case was checked by plain CT and enhanced MRI.CT and MRI showed that 7 cases had a round or elliptical soft tissue mass, and 4 cases with well defined margin,3 cases were not clear in edge,2 cases with spot or strip calcification on CT images,4 cases had slightly longer T1 and longer T2 signal,4 cases were restricted of diffusion and had higher signal on DWI.All the lesions were enhanced in arterial phase,and went on in the delayed phase.There were 5 cases with distorted vascular shadow in the middle and/or around of the mass, 3 cases with strips,spoke-like low-density areas or low-signal areas,and some lesions were filled in delayed phase.Conclusion CT and MRI features of hyaline vascular type LCD have certain characteristics such as rich blood supply,enhancement in persistent,tortuosity of peripheral vascular,with some short strip calcification and high signal on DWI,which may be helpful for preoperative diagnosis.
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Objective To investigate the clinical efficacy of modified tracer minimally invasive fixation in robot-assisted pedicle screw placement. Methods A prospective randomized controlled study was conducted to analyze the clinical data of 41 patients with thoracolumbar fresh fracture at the orthopaedics department of Karamay Central Hospital from July 2017 to December 2017. There were 20 males and 21 females, aged 25-55 years, with an average of 40. 6 years. According to AO fracture typing, there were 28 patients with type A and 13 patients with type B. The patients underwent robot-assisted pedicle screw placement. Random number table method was used to divide the patients into the conventional group (20 patients) and modified group (21 patients). The conventional group was treated with conventional tracer fixation, and the modified group modified tracer minimally invasive fixation. A total of 92 pedicle screws were implanted in the conventional group and 96 pedicle screws were implanted in the modified group. The size of wound, wound bleeding, time of fixing the tracer, complications (spinal cord injury and nerve root injury when fixing the tracer), development of the tracer fixator and artifacts were recorded. The accuracy of nail placement was evaluated by 320-slice CT scan and Gertzbein-Robbins criteria. Results There was no significant difference in age, sex, diagnosis, transverse diameter of pedicle and e angle between the two groups (P>0. 05). The wound size, wound bleeding, and time of fixing the tracer in the modified group were (6. 00 ± 1. 26)mm,(1. 38 ± 0. 22)ml and (1.42 ±0.17)minutes, respectively, while those of the conventional group were (40. 16 ± 5. 71)mm, (11.61 ±1.15)ml, and (5.12 ±0.64)minutes respectively (P<0.05). No spinal cord or nerve root injury occurred in either group when the tracer was fixed. In the process of three-dimensional image acquisition and automatic registration, the tracer fixator in the modified group developed with Kirschner needle without artifacts, and the tracer in minimally invasive fixator had good fluoroscopy effect. The modified group included 94 pedicle screws of type A and two of type B according to Gertzbein-Robbins criteria. The conventional group included 89 pedicle screws of type A and three of type B according to Gertzbein-Robbins criteria. There was no significant difference in the screw placement accuracy between the two groups (P>0. 05). Conclusion In the robot-assisted pedicle screw placement, the modified tracer minimally invasive fixation method is safe and less traumatic, with no side effect on the accuracy of pedicle screw placement.
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Immunoglobulin G4 (IgG4)-related disease is a chronic progressive autoimmune disease involving multiple systems throughout the body. IgG4-related hepatobiliary and pancreatic diseases are the manifestation of IgG4-related disease involving the hepatobiliary and pancreatic systems, with the main features of an increased serum IgG4 level and IgG4-positive lymphoplasmacytic infiltration. IgG4-related hepatobiliary and pancreatic diseases can mimic various inflammations and tumor diseases, which may lead to missed diagnosis and misdiagnosis in clinical practice. This article elaborates on the pathogenesis of IgG4-related hepatobiliary and pancreatic diseases from the perspectives of genetic inheritance, infection and molecular mimicry, and immune factors, so as to improve the understanding of such diseases.
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Objective To investigate the clinical features of cutaneous adverse reactions to tyrosine kinase inhibitors.Methods Thirty patients with cutaneous adverse reactions to tyrosine kinase inhibitors were enrolled from the First Affiliated Hospital of Guangzhou Medical University between January 2015 and December 2016,and their laboratory test results,histopathological findings and treatment response data were collected and analyzed retrospectively.Results Of the 30 patients,15 presented with acneiform eruptions,10 with eczematoid eruptions,2 with morbilliform rashes,1 with telangiectasia,1 with hand-foot skin reaction,9 with xerosis,7 with nail changes and 4 with hair changes.A patient with grade 4 acneiform eruptions showed a markedly elevated alanine transaminase (ALT) level (315 U/L).Mild ALT abnormalities (48.5-88.1 U/L) were found in 3 patients with grade 3 acneiform eruptions,1 with grade 2 acneiform eruptions,1 with grade 1 acneiform eruptions and 1 with eczematoid eruptions complicated by fever.Two patients with eczematoid eruptions and 1 with morbilliform rashes showed elevated proportions of peripheral blood eosinophils (0.057-0.303).Pathological changes of the acneiform eruptions included hyperkeratosis and dilation of hair follicles and neutrophilic infiltration.Pathological manifestations of eczematoid eruptions included different degrees of spongiosis,thickened spinous layer,irregular elongation of rete ridges and liquefaction degeneration of basal cells in the epidermis,and perivascular infiltration of lymphocytes and eosinophils in the superficial dermis.Patients with grade 1-3 acneiform eruptions received oral minocycline for 6 weeks,skin lesions gradually regressed,but relapse occurred after the withdrawal.After withdrawal of targeted antineoplastic agents and 2-week treatment with systemic glucocorticoids,skin lesions gradually regressed in patients with grade 4 acneiform eruptions,those with eczematoid eruptions complicated by fever,and those with morbilliform rashes.Skin rashes also resolved in patients with mild morbilliform rashes and those with mild eczematoid eruptions after 2 weeks of treatment with antianaphylactic agents and topical glucocorticoids.Oral antibiotics were effective for the treatment of periungual erythematous swelling or granulomas.Conclusion Tyrosine kinase inhibitor-related cutaneous adverse reactions include a constellation of disorders,and hepatic function can be impaired.
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Objective@#To analyze the treatment of advanced non-small cell lung cancer (NSCLC) with performance status (PS) scores between 2 and 4, in order to improve the diagnosis and treatment of these patients.@*Methods@#A total of 36 patients with advanced NSCLC with hypoxemia were reviewed. The clinical data of disease characteristics, etiology, complications, manifestation, therapy, progression, and secondary biopsy were collected. The clinical efficacy was graded according to the Response Evaluation Criteria In Solid Tumors (RECIST): complete response (CR), partial response (PR), stable disease (SD) and disease progression (PD).@*Results@#All patients had hypoxemia, of whom 86.1% (31 patients) had complications and 55.6% (20 patients) had noninvasive ventilator for respiratory support. 77.8% (28 cases) received broad-spectrum antibiotic treatment, and 78.6% of them got lung osmotic relief after the anti-infection treatment. 15 cases received bedside fiberoptic bronchoscopy suction, of whom two cases were treated with airway stent deposition due to airway obstruction, four cases with thoracic drainage, four cases with anticoagulation, and one with thrombolytic therapy. After these supportive treatment, the PS score of these patients decreased from 3.4±0.5 to 2.5±0.7, while SPO2 improved from (89.0±5.2)% to (95.0±3.5)%. As first-ling anti-cancer treatment, nine patients were administrated with targeted medicine orally, 13 patients with a combined chemotherapy of pemetrexed plus bevacizumab or carboplatin, eight patients with paclitaxel plus carboplatin, four patients with gemcitabine plus carboplatin, and two patients with docetaxel plus gemcitabine. In the first response evaluation, there were one case of CR, 23 cases of PR, four cases of SD, and eight cases of PD, with a clinical benefit rate of 66.7% and a disease control rate of 77.8%. A total of 22 patients experienced disease progression, of whom eight cases had a secondary biopsy and six cases had gene sequencing. Of these 36 patients, 10 (27.8%) patients survived at the last follow-up, with a progression-free survival of (10.0±6.5) months.@*Conclusion@#Besides prompt anti-cancer treatment and best supportive treatment should be incorporated to improve PS and improve outcome.
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It was recently shown that several new synthetic 2-alkylsulfanyl-6-benzyl-3, 4-dihydropyrimidin-4(3H)-one (S-DABO) derivatives demonstrated anti-HIV-1 activity. Three of the derivatives namely RZK-4, RZK-5 and RZK-6 were used in this study to explore their inhibitory effects on a variety of HIV strains. These compounds at a concentration of 200 microg mL(-1) almost completely inhibited the activity of recombinant HIV-1 reverse transcriptase. All of the three compounds reduced replication of HIV-1 laboratory-derived strains, low-passage clinical isolated strain, and the drug resistant strain. In particular RZK-6 showed potent activity against the HIV-1 drug resistant strain. In general, the antiviral activities are similar in magnitude to nevirapine (NVP), which is a non-nucleoside reverse transcriptase inhibitor approved by FDA. The therapeutic indexes of these compounds were remarkable, ranging from 3704 to 38462 indicating extremely low cytotoxicity. These results suggest that the three S-DABO derivatives in this study have good potential for further development in anti-HIV-1 therapy. It may be particularly useful to target at the non-nucleoside reverse transcriptase inhibitors resistant HIV-1 strain.
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Objective: To observe the therapeutic effect of acupuncture therapy for treatment of chronic atrophic gastritis. Methods: According to the theory of TCM, 36 cases of chronic atrophic gastritis were differentiated and treated by acupuncture. Gastroscopy and electrogastrograph (EGG) of the body surface, gastric acid and pepsin, blood gastrin, blood prostaglandin E (PGE), gastric mucosal cells and G cells are recorded. Results: Acupuncture therapy had a better effect in improving clinical symptoms, the markedly effective rate was 97.2% and the disappearing rate of clinical manifestations 97.02%;after acupuncture treatment,blood PGE concentration increased; gastric acid secretion increased; gastric dynamics was enhanced and the amplitude of EGG rose; acupuncture could significantly facilitate secretion of gastrin. Conclusion: Acupuncture is a convenient treatment method for atrophic gastritis with quick effect and without side effects.