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In order to solve the difficulties and challenges in the implementation of the original blood distribution and collection regulations caused by the expansion of hospital area, the extension of blood transfer time, the changeability of blood transfer environment, and the strain of personnel due to the increase of workload, as well as to ensure the accuracy of the information throughout blood remote verification and distribution and the safety of clinical blood transfusion, , Shanghai experts related to clinical transfusion and blood management had made a systematic study on the applicable scope and management rules of remote verification of blood distribution and collection, and formulated this Expert Consensus combined with the development status of digital, intelligent and remote communication technologies, so as to provide corresponding guidance for clinical medical institutions in line with the changes in reality.
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Objective To investigate the relationship between CYP 2C19 gene polymorphisms and clopidogrel efficacy in coronary heart disease patients after percutaneous coronary intervention (PCI).Methods From January 2016 to December 2017,62 patients with acute coronary syndromes and treated with PCI in Guizhou Aerospace Hospital were recruited, CYP2C19 genotype, ADP －induced platelet aggregation rate and myocardial enzymes and other indicators were detected before operation .The myocardial enzymes were measured 24 hours after PCI.According to different metabolic types,the patients were grouped,the above indicators were compared.Results The CYP2C19*1/*1 was 37.10%,CYP2C19*1/*2 was 35.48%,CYP2C19*1/*3 was 11.29%,CYP2C19*2/*2 was 12.90%,CYP2C19*2/*3 was 3.23% and CYP2C19*3/*3 was 0.00%.The LDH,AST,CK,CK－MB and α－HBDH in the PCI patients after operation were significantly higher than those before operation (t＝0.019,0.040, 0.044,0.022,0.014,all P＜0.05).But ADP induced platelet aggregation rate and myocardial enzymes and other indicators among fast metabolism group,intermediate metabolic group and slow metabolic group had no statistically significant differences (all P ＞0.05).Conclusion CYP2C19 mutation frequency in the Chinese population is relatively large,the sample size of this study is less ,the relationship between clopidogrel resistance and the specific genotype can not be obtained ,it need to increase the sample size and comprehensive multi －factor consideration .
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OBJECTIVE@#To investigate the surgical effect and complications of arytenoid resection in bilateral vocal cord fold paralysis(BVFP) patients via endoscopic laser approach and external cervical approach.@*METHOD@#A total seventy-eight BVFP patients who underwent arytenoid resection surgery via endoscopic laser approach (laser group, n=30) or external cervical approach (external cervical group, n=48) were enrolled in this study. Videostroboscopy, vocal perception evaluation, maximum phonation time (MPT) text were preformed in all patients both preoperatively and postoperatively. The decannulation rate was also calculated.@*RESULT@#Videostroboscopy showed that vocal fold on the operated side in both groups could abduct to various extent postoperatively, which showed significant difference when compared with preoperative abductive movements (P 0. 05). Postoperative videostroboscopy showed no significant difference in vocal fold position and glottal closure between these two groups(P>0. 05). Vocal perceptual evaluation(RBH score) showed a significant deterioration in voice quality postoperatively in both groups respectively (P. 05). However, they were significantly shorten/shorter than preoperative ones in these two groups respectively (P<0. 05). The overall decannulation rate were 90. 0% and 95. 8% for laser group and external cervical group respectively. In Both groups, patients presented aspiration symptoms postoperatively, except one patient of external cervical group who developed pneumonia due to recurrent aspiration.@*CONCLUSION@#Arytenoid resection surgery via both endoscopic laser approach and external cervical approach can both enlarge glottic area so as to solve respiration problems, in BVFP patients. Two kinds of surgery have obvious voice damage.
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Humans , Arytenoid Cartilage , General Surgery , Endoscopy , Methods , Lasers , Neck , General Surgery , Postoperative Complications , Postoperative Period , Vocal Cord Paralysis , General Surgery , Vocal Cords , Voice QualityABSTRACT
Objective To investigate the morphology change of posterior cricoarytenoid muscle myofiber in patients with idiopathic vocal fold paralysis and to provide experimental evidence for the clinical treatment of idio‐pathic vocal cord paralysis .Methods Thirty -nine cases of vocal fold paralysis patients were recruited into and di‐vided into 2 groups :idiopathic vocal cord paralysis group(n=16) ,and traumatic vocal cord paralysis group(n=23) . Both groups were further divided into 3 subgroups:0 .5~1 year(5 cases and 7 cases) ,>1~2 years(5 cases and 10 cases) ,>2 years(6 cases and 6 cases) .Part of posterior cricoarytenoid muscle(PCAM ) were acquired from all of vo‐cal cord paralysis patients .Normal human posterior cricoarytenoid muscles were treated as the control group (n=5) . They were all stained with Masson three-color staining ,the fiber crosssectional area of muscle tissue and collagen connective tissue were quantitatively analyzed with the image pro plus analysis system .Differences of two observa‐tion indexes were compared with each other among groups and subgroups .Results The number of myofibers was decreased ,but the numbers of the collagen fibers was increased with the onset time course extension ,the ratio of cross sectional area of myofibers to those of collagen fibers was progressively decreasd with increased time course of denervation and more decrease within 1 year .There was obvious difference between the control group and 0 .5~1 year ,>1~2 years ,>2 years subgroup of idiopathic vocal cord paralysis (P1~2 years subgroup and >2 years subgroup ,the trend of shrinking still existed .Com‐pared two observation indexes of traumatic vocal cord paralysis with the same period subgroup indexes of idiopathic vocal fold paralysis ,there was no significant difference about these two observation indexes (P>0 .05) .In some special cases with 10 years duration in idiopathic vocal cord paralysis group ,the posterior cricoarytenoid muscle at‐rophy fibrosis was not serious .However ,in some case which the course lasted for only 1 .5 years ,the muscle atrophy was very obvious .There were great individual differences among idiopathic vocal cord paralysis patients .Conclusion If there is no recovery after half year treatment ,for PCA muscle function recovery ,the recurrent laryngeal nerve injury repair surgery could be considered to carry out within 1 year .In some cases with long disease duration (>2 years) ,they may still have the muscle morphological basis for nerve repair .
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Objective:This study aimed to compare the efficacy and adverse reactions of two different chemotherapeutic regi-mens. In particular, chemotherapy with paclitaxel liposome was administered in combination with either S-1 or oxaliplatin as the first-line therapy of advanced gastric cancer. Methods:A total of 118 patients with advanced gastric cancer were randomly divided into groups A (61 cases) and B (57 cases). In group A, paclitaxel liposome combined with S-1 was administered;in group B, paclitaxel lipo-some combined with oxaliplatin was applied. The short-term efficacy, adverse reactions, Karnofsky performance status score, median time to progression (mTTP), and median overall survival (mOS) of the two groups were observed and compared. Results:No signifi-cant differences were observed in the objective response rate, disease control rate, and mTTP between groups A and B (31.1% vs. 29.8%, 75.4%vs. 71.9%, 4.2 months vs. 3.8 months;P>0.05). The mOS rates were 10.5 and 8.9 months in groups A and B, respectively, with statistically significant differences (P=0.006). The incidence of degreesⅢtoⅣdiarrhea and peripheral nerve toxicity was signifi-cantly higher in group B than in group A (P<0.05). No statistical differences were found between the two groups in terms of other side effects. Conclusion:The two paclitaxel liposome-based regimens showed similar therapeutic effect in patients with advanced gastric cancer. S-1/paclitaxel liposome treatment could be more effective in terms of mOS and had a tendency of lower toxicity.