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Retinal vein occlusion(RVO), the second most prevalent retinal vascular disease, has complex pathophysiological mechanism. Except for mechanical pressure on blood vessel, inflammation and endothelin have been confirmed to be involved in the pathogenesis of RVO. However, its specific mechanism remains unclear. Hypertension, diabetes and dyslipidemia have been previously shown to be the most common risk factors in elder population, while recent studies found that coagulation and hemorheological abnormalities are more common in people under 50 years old. Ocular risk factors including glaucoma, high corrected intraocular pressure and retinal vessels abnormality, have gained more and more attention. These factors probably exert a synergistic effect when present simultaneously in the same patient. Therefore, early identification and intervention of those factors could lower the incidence of RVO. This article aims to review recent research and summarize existing mechanism and theories, giving some new research ideas for potential therapy targets and providing references for identification and management of risk factors.
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Objective:To explore the efficacy and safety of methimazole combined with levothyroxine in the treatment of patients with Graves disease (GD), and provide theoretical basis for clinical practice.Methods:Sixty-eight patients with confirmed GD who admitted to the 903rd Hospital of PLA from January 2013 to January 2018 were selected and divided into control group and observation group by random number table method.The control group was given propylthiouracil combined with levothyroxine.The observation group was treated with methimazole and levothyroxine.The clinical features of hyperthyroidism, changes in hormone levels, and bone metabolism were compared between the two groups before and after treatment.Results:After treatment, the incidence of exophthalmos, goiter and thyrotropin receptor antibody (TRAb) positive rate were significantly reduced in the two groups (the control group changed from 10 cases to 2 cases, and the observation group changed from 10 cases to 0 case), the differences were statistically significant (χ 2=27.1, 16.2, all P<0.05). The differences in TSH, FT 3, and FT 4 before and after treatment were statistically significant [the control group: TSH changed from (0.02±0.02)mU/L to (3.01±0.94)mU/L, FT 3 from (16.92±2.25)pmol/L to (10.29±1.68)pmol/L, FT 4 from (52.61±10.22)pmol/L to (19.82±4.11)pmol/L; the observation group: TSH from (0.02±0.01)mU/L to (1.97±1.27)mU/L, FT 3 from (17.09±2.72)pmol/L to (3.95±0.84)pmol/L, and FT 4 from (53.82±10.11)pmol/L to (12.65±3.31)pmol/L], and the improvement of TSH, FT 3 and FT 4 in the observation group were better than those in the control group ( t=3.24, 9.51, 16.31, all P<0.05). After treatment, the levels of PTH, CT, blood calcium, blood phosphorus were increased [the control group: PTH changed from (38.32±11.41)ng/L to (42.83±14.22)ng/L, CT changed from (8.66±2.22)ng/mL to (8.01±4.55)ng/mL, blood calcium level changed from (2.01±0.12)pmol/L to (2.53±0.20)pmol/L, blood phosphorus level changed from (1.12±0.08)pmol/L to (1.37±0.09)pmol/L; the observation group: PTH changed from (38.31±12.52)ng/L to (46.33±15.03)ng/L, CT changed from (8.45±2.21)ng/mL to (11.49±7.33)ng/mL, the calcium level changed from (2.02±0.98)pmol/L to (2.82±0.87)pmol/L, the blood phosphorus level changed from (1.10±0.07)pmol/L to (1.42±0.16)pmol/L]. The improvement of PTH and CT in the observation group was better than those in the control group ( t=6.51, 7.31, all P<0.05). Conclusion:Methimazole combined with levothyroxine in the treatment of GD has good therapeutic effect on the clinical characteristics of hyperthyroidism, changes in hormone levels, and bone metabolism.The clinical efficacy is reliable and there are few adverse reactions, which deserves clinical reference.
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Objective@#To compare the clinical effects between laparoscopic cholecystectomy and choledochotomy versus traditional open cholecystectomy plus choledochotomy.@*Methods@#One hundred and sixty-eight elderly patients with gallbladder and choledocholithiasis were divided into a laparoscopy group(n=75, receiving laparoscopic cholecystectomy and choledochotomy)and an open abdominal group(n=93, undergoing traditional open cholecystectomy and common bile duct exploration). The surgical incision length, operation time, intraoperative blood loss, anal exhaust time, hospital stay and postoperative complications were compared between the two groups.@*Results@#The surgical incision length, operation time, intraoperative blood loss, anal exhaust time, hospital stay were lower in the laparoscopic group than in the open abdominal group(P<0.05). The incidence of postoperative complications was lower in the laparoscopic group than in the open group(P<0.05).@*Conclusions@#Laparoscopic cholecystectomy and choledochotomy can obviously improve the clinical efficacy and reduce complications in elderly patients with gallbladder and choledocholithiasis, and it is worthy of clinical application.
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Objective To compare the clinical effects between laparoscopic cholecystectomy and choledochotomy versus traditional open cholecystectomy plus choledochotomy.Methods One hundred and sixty-eight elderly patients with gallbladder and choledocholithiasis were divided into a laparoscopy group(n=75,receiving laparoscopic cholecystectomy and choledochotomy)and an open abdominal group (n =93,undergoing traditional open cholecystectomy and common bile duct exploration).The surgical incision length,operation time,intraoperative blood loss,anal exhaust time,hospital stay and postoperative complications were compared between the two groups.Results The surgical incision length,operation time,intraoperative blood loss,anal exhaust time,hospital stay were lower in the laparoscopic group than in the open abdominal group (P ＜ 0.05).The incidence of postoperative complications was lower in the laparoscopic group than in the open group(P＜0.05).Conclusions Laparoscopic cholecystectomy and choledochotomy can obviously improve the clinical efficacy and reduce complications in elderly patients with gallbladder and choledocholithiasis,and it is worthy of clinical application.
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In recent years, the continuous growth of drug costs has become one of the hot issues of society. In this paper, by using principles and methods of pharmacoeconomics, we study on the management of drug cost control in hospital. Pharmacoeconomics involves the effective allocation and rational use of drug resources, and study the economic effect, that is to carry out the study of drug resources utilization efficiency. Through the analysis of the cost-benefit analysis of drug treatment, we could find the a more cost-effective treatment. Pharmacoeconomics can be applied to the clinical diagnosis and treatment, make reasonable prescription cost effect, it could provide patients with high economic efficiency of treatment, so that drug treatment to achieve the best results
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Economics, Pharmaceutical , Cost-Benefit Analysis , HospitalsABSTRACT
Objective: To discuss the pathogenesis,clinical manifestations,diagnosis,differential diagnosis, treatment,and prognosis of the patient with rituximab (RTX)-induced interstitial lung disease (ILD) (RTX-ILD).Methods:A male patient aged 19 years old was confirmed as classical Hodgkin's lymphoma more than 2 years ago,and received autologous hemopoietic stem cell transplantation (HSCT)when the disease recurred 1 year ago.Two months after HSCT,the maintenance chemotherapy was given every month with 375 mg· m-2 RTX,but the mediastinal recurrence appeared during the period,then the mediastinal residual lesion radiotherapy was done for 10 times.However,8 d after the third RTX chemotherapy,the patient experienced post-exercising tachypnea,fever,cough,chest congestion,and limb weakness.The chest CT scanning results suggested ground gloss opacity on both lungs,and blood gas analysis suggested a hypoxemia.Neither antibacterial nor antifungal treatment worked well.Afterwards,the sequential etiological examination showed the negative results,and the bronchoscope examination showed the normal results as well.Considering about the possibility of RTX-ILD,RTX was stopped immediately and turned to intravenous infusion of methylprednisolone 40 mg per day.Results:Five d later,the symptoms of the patients were improved,and the follow-up methylprednisolone was changed to oral and gradually reduced to discontinuation.Conclusion:RTX-ILD is relatively rare,and its clinical manifestations lack specificity. Hormonotherapy is the main method in treatment of RTX-ILD. The patients sensitive to hormonotherapy have better prognosis than those insensitive to hormonotherapy.
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Children usually come to emergency department accompanied with painful conditions and injuries.During the emergence care,additional painful,distressing or unpleasant diagnostic and therapeutic procedures may be required.Emergency doctors are anticipated to provide safe and effective analgesia and se-dation for children.This review summarized recent studies on the following aspects:make sure that children do not experience lengthened or additional pain when coming to emergency medical care;at triage use a com-posite pain assessment tool to assess;aim to provide effective analgesia at the first attempt-use the appropriate drug,dose,and route;choose painless modes of delivery(nasal route,flavoured syrups) if possible;reassess frequently pain scores to make sure that analgesia is effective and allow adequate time for it to work;use non-pharmacological and pharmacological modalities to manage pain;avoid the"routine"use of unnecessary painful invasive procedures;use topical,local and regional anaesthesia together with proper safe procedural se-dation to avoid further pain.
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AIM: To explore the effect of pyrrolidine dithiocarbamate (PDTC), an NF-κB inhibitor, on the proliferation and apoptosis of human multiple myeloma U266 cells and its mechanisms.METHODS: The U266 cells were treated with PDTC at different concentrations (0, 25, 50, 100 and 200 μmol/L) in vitro.The growth inhibitory rate of the U266 cells was detected by CCK-8 assay and cell counting.The cell cycle of the U266 cells was determined by flow cyto-metry, and the apoptosis was examined by flow cytometry with Annexin V-FITC/PI staining.The effect of PDTC on the expression of DNA methyltransferase 1 (DNMT1) at mRNA and protein levels was measured by RT-qPCR and Western blot, respectively.The effects of PDTC on the protein levels of NF-κB (P65), DNMT1, Bcl-2, cyclin D1, cleaved caspase-3 and cleaved caspase-8 were determined by Western blot.RESULTS: The protein level of NF-κB (P65) was decreased after treatment with PDTC for 48 h or 72 h.PDTC inhibited the proliferation of U266 cells in both dose-and time-dependent manners.After treatment with PDTC for 48 h, the percentage of U266 cells in G2 phase increased compared with control group (P<0.05).PDTC induced the apoptosis of U266 cells in a dose-dependent manner.The expression of DNMT1 at mRNA and protein levels decreased (P<0.05).The results of Western blot showed that the expression of Bcl-2 in PDTC groups decreased, while the protein levels of cyclin D1, cleaved caspase-3 and cleaved caspase-8 were higher than those in control group (P<0.05).CONCLUSION: The NF-κB inhibitor PDTC inhibits the proliferation of U266 cells by inducing cell apoptosis.It may be related to the down-regulated expression of DNMT1, cell cycle arrest and activation of the apoptotic pathways.
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Objective To analyze the clinical efficacy and outcomes of adult patients who underwent ABO-incompatible living donor liver transplantation.Methods The clinical data of 7 patients who underwent ABO-incompatible living donor liver transplantation at the Henan Provincial People's Hospital and Zhengzhou People's Hospital from January 2013 to December 2015 were analyzed retrospectively.Age,gender,primary disease,blood type antibody level,graft volume/standard liver volume (GV/SLV),postoperative complications and prognosis were analyzed.Results The recipients' average GV/SLV was 52.0％.There were 4 recipients who underwent splenectomy,including 3 patients who underwent the procedure concurrently,and one patient who underwent the procedure a few years before,the liver transplantation.Seven recipients were treated with plasmapheresis,Rituximab and Basiliximab.No patients experienced acute rejection during the perioperative period,and the 1-year survival rate was 85.7％ (6/7).Conclusion ABOincompatible liver transplantation in adult living donor can have favorable clinical outcomes using appropriate preoperative evaluation for recipients,optimized surgical procedures,pretransplant plasmapheresis,and perioperative Rituximab,Basiliximab injection and intravenous immunoglobulin administration.
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Objective To analyze the relationship between cystatin C(Cys C) and homocysteine(Hcy) in patients with early diabetic nephropathy.Methods48 cases of T2DM patients from June 2013 to December 2015 in our hospital for treatment were chosen as the observation group, including 30 patients with early diabetic nephropathy patients as the observation group 1, 18 cases of T2DM patients as the observation group 2, were selected in our hospital physical examination of 28 healthy persons as control group,serum Cys C and Hcy levels were measured at the same time, urinary albumin / creatinine ratio (Ualb/cr) was measured in the observation group, test results of three groups were analyzed and compared.ResultsThe serum Cys C and Hcy in the observation group were significantly higher than the control group, and Cys C and Hcy levels in observed 1 group were significantly higher than that observed in the 2 group, the difference was statistically significant in the observation group, serum Cys C and Hcy level was positively correlated with Ualb/cr.ConclusionThe relationship between Cys C and Hcy levels and early diabetic nephropathy has very important significance in the early diagnosis of diabetic nephropathy, can effectively improve the rate of diagnosis of early diabetic nephropathy patients.
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AIM:To investigate the relationship of autophagy and reactive oxygen species ( ROS) in multiple myeloma cell line RPMI-8226 stimulated with doxorubicin.METHODS:The RPMI-8226 cells were stimulated with doxo-rubicin at different doses, and untreated cells were used as control.The protein expression of beclin 1 and LC3 was detec-ted by Western blot.ROS production was analyzed by DCFH-DA fluorescence staining.After treated with or without 3-methyladenine (3-MA), the ROS production and apoptosis in RPMI-8226 cells were determined by DCFH-DA and flow cy-tometry, respectively.After treated with or without antioxidants tempol and N-acetyl-L-cysteine ( NAC) , the expression of beclin 1 and LC3 in RPMI-8226 cells was determined by Western blot.RESULTS:The protein levels of beclin 1 and LC3Ⅱ/LC3Ⅰwere increased in the RPMI-8226 cells stimulated with doxorubicin compared with untreated group.The ROS production was increased in the RPMI-8226 cells stimulated with 2 mg/L doxorubicin compared with untreated group.After treated with 3-MA, the ROS production and apoptosis in the RPMI-8226 cells stimulated with doxorubicin were increased compared with doxorubicin group.After treated with antioxidant NAC or tempol, the expression of beclin 1 and LC3 II/I in the RPMI-8226 cells stimulated with doxorubicin was decreased compared with doxorubicin group.CONCLUSION:The autophagy and ROS levels are increased in RPMI-8226 cells stimulated with doxorubicin.Inhibition of autophagy increases the ROS production and apoptosis of RPMI-8226 cells stimulated with doxorubicin.Inhibition of ROS production reduces doxorubicin-induced autophagy in multiple myeloma cells.
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Single-supervisor system is the widespread practice for graduates of clinical medicine at present. But in terms of education to clinical medical graduate students, students rotate in the departments of various disciplines for a long time, and there are more rotary department, resulting in some students' unbalanced learning development. Combined with the charac-teristics of the department of hematology, multi-supervisors training model was carried out to the rotating masters of other disciplines when they rotated in hematology department. With supervisor equipment and teaching implementation, we applied the principle of integrating theory with practice and trained students' innovation ability and doctor-patient communication ability. Compared with traditional single supervisor training pattern, multi-supervisors system can effec-tively improve the students' theoretical level, practical skills and comprehensive ability when the clinical medical graduate students rotate in the department of hematology.
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Objective To investigate the safety , feasibility , and clinical application value of digital sub-traction angiography ( DSA) -guided insertion of totally implantable venous access port ( TIVAP) in patients with digestive system cancer .Methods We retrospectively analyzed the data of 15 digestive system cancer patients who were inserted with TIVAP under DSA guidance between April 2013 and January 2016, recorded the TIVAP-related complications and indwelling time, and investigated the patients’satisfaction about TIVAP.Paired rank sum test was used for the differences in patients’quality of life before and after the insertion of TIVAP.Results Of the 15 digestive system cancer patients , operation success rate of TIVAP insertion was 100%, with the success rate of venipuncture on first attempt being 100%.The incidence of complication was 6.67% ( 1/15 ) , which was manifested as pull feeling at the neck occurring in the eighth month after insertion .The indwelling time of TIVAP was from 2 to 28 months, with a median value of 9 months.Patients’satisfaction rate of TIVAP was 86.67%(13/15).The proportion of patients with a good quality of life was 100%(15/15), statically signifi-cantly higher than that before the insertion [46.67%(7/15), Z=-3.416, P=0.000).Conclusions TIVAP insertion under DSA guidance in digestive system cancer patients is safe and feasible , with few complications and fair patient satisfaction .It may improve the patient ’s quality of life , worthy of clinical application .
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<p><b>OBJECTIVE</b>To investigate the diagnosis and treatment of hypotelorism.</p><p><b>METHODS</b>From Jan. 2000 to Jan. 2014, 6 cases with hypotelorism were retrospectively studied. Among them, 3 cases had craniosynostosis, 2 had holoprosencephaly, and 1 had cleft lip. All the cases were diagnosed and treated by bone graft or spring distraction to correct the hypotelorism.</p><p><b>RESULTS</b>2 cases were treated by none graft and 4 cases were treated by external spring distraction. All the patients completed the treatment successfully with obvious improvement in appearance. No complication happened. 4 cases were followed up for 2 years with an average fronto-orbital axis angle as (50 ± 8) °.</p><p><b>CONCLUSIONS</b>Hypotelorism can be successfully corrected by bone graft as fronto-orbital bridge or spring distraction.</p>
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Humans , Bone Transplantation , Cleft Lip , Craniofacial Dysostosis , Diagnosis , General Surgery , Craniosynostoses , Osteogenesis, Distraction , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To analyze and evaluate the joint teaching of subspeciahy teachers in the application of diagnostics probation.Methods 293 clinical medical undergraduates of Grade 2009 were randomly divided into experimental group(the joint subspeciahies teaching group,n=153) and control group(traditional teaching group,n=140).The two groups of students were divided into the 14-16 study group.The diagnostics probation teaching content(all general physical examination and ECG examination)was decomposed in the experiment group and students were taught by different subspecialties teachers while the students of the control group were taught by a teacher of internal medicine.The final examination grades and operative performance of the two groups were compared,evaluated and U tested.At the same time the questionnaire smvey was conducted to the students in the experimental group.Results The experimental group's theory examination score was (75.2 ± 8.9) and the operative assessment score was (88.5 ± 6.2),higher than that in the control group(70.9 ± 10.7 and 84.6 ± 5.5),the difference was statistically significant(P=0.001).The questionnaire results showed 92.8％(142/153)medical students improved their clinical skill,86.9％(133/153) medical students were satisfied with the joint teaching of subspecialty teachers.Conclusions The subspecialty teachers' joint teaching can improve students' clinical practice ability.It is a valuable teaching method in diagnostics teaching.
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Objective To investigate the effect of traditional Chinese medicine combined with five steps of neck manipulation in treating cervical vertigo.Methods From 2010 October to 2012 October,90 patients with cervical vertigo in our department inpatient and outpatient, according to the order of admission or the visiting sequence, were randomly divided into a control group and a observation group, 45 cases in each group. The control group was given traditional Chinese medicine decoction with cervical traction; the observation group was given the TCM recipe combined with five steps of neck manipulation”. The vertigo symptoms, functional evaluation and clinical efficacy were observed in both groups.Results After the treatment, the clinical symptoms and functional assessment scale scores of the observation group was significantly lower than that in control group(t=6.942,P<0.05), improve index in the observation group was better than that in control group(t=6.831,P<0.05). The cure rate and the effective rate of the observation group(88.89%)was also better than that in control group(66.67%),χ2=6.738,P<0.05. Conclusion Traditional Chinese medicine combined with five steps of neck manipulation can actually improve symptoms and function effect in treating cervical vertigo, worthy of further study.
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Objective To assess the efficacy of combination therapy with all-trans-retinoic acid (ATRA ) and arsenic trioxide (ATO) in treating patients with acute promyelocytic leukemia (APL) .Methods A retrospective study was conducted to evaluate the efficacy of combining ATO with ATRA based induction therapy ,followed by 3 courses of consolidation chemotherapy and 2-year sequential ATO/ATRA maintenance therapy in newly diagnosed APL ,and the efficacy between high risk group and low/inter-mediate risk group ,also between different PML-RARa isoform sub-group were compared .Results In high risk group and low/in-termediate risk group ,the complete remission(CR)rates were 70 .0% and 96 .9% (P=0 .04) ,respectively ;the 3 years overall sur-vival rates(OS) and disease free survival rates (DFS) were(70 .0 ± 14 .5)% ,(96 .9 ± 3 .1)% ,P= 0 .01 and(66 .7% ± 19 .2)% , (93 .8 ± 6 .1)% ,P=0 .08 ,respectively .In BCR1 group and BCR3 group ,the CR were 78 .6% and 95 .6% (P=0 .14) ,respectively ;the rates of 3 years OS and DFS were(95 .7 ± 4 .3)% ,(78 .6 ± 11 .0)% ,P=0 .18 ,and(92 .9 ± 6 .9)% ,(87 .5 ± 11 .7)% ,P=0 .24 , respectively .Conclusion The results indicate that ATO based first-line protocol is highly effective for treatment of newly diagnosed APL ,especially for the PML-RARa BCR3 isoform APL .
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Objective To investigate the diagnosis and treatment of post-transplant lymphoproliferative disease (PTLD) after hematopoietic stem cell transplantation (HSCT).Methods Clinical data of one case of PTLD,including clinical manifestations,diagnosis and treatment,were retrospectively analyzed.And the related literatures were reviewed.Results From January 2007 to November 2012,one case developed PTLD among 196 patients who were followed up after HSCT in the First Affiliated Hospital of Chongqing Medical University.The incidence of PTLD was 0.5％.Clinical manifestations of the patient were not typical,including frequent fever,multiple lymphadenopathy and multiple pulmonary nodules.The patient was diagnosed as diffuse large B-cell lymphoma (B-DLCL) by pathological examination of the swollen lymph node.After withdrawal of immunosuppressants,the temperature returned to normal,and lymphadenopathy and pulmonary nodules disappeared completely.Conclusion PTLD is a severe complication of HSCT with distinctive morphologic and clinical characteristics.The origin of this disease may be associated with Epstein-Barr virus infection and imrnunosuppressive therapy.It needs the pathologic detection to make a definite diagnosis.Several different treatment strategies have been employed,and reduction of immunosuppressive therapy may lead to regression of PTLD.
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Objective To investigate the expression of Foxp3+ Treg in liver cancer patients receiving liver transplant after immunosuppressive protocols FK506 or Rapamycin and evaluate the rejection prevention.Methods Liver transplant patients were randomly divided into FK506 group (10 cases),and Rapamycin group (10 cases).Real time quantitatve PCR was used to examine Foxp3 mRNA expression of patients' PBMC starting the 2nd month for consecutively 10 months.Foxp3 mRNA and incidences of acute rejection were compared between the two groups.Results Foxp3 mRNA expression was significantly lower in the FK506 group (0.1032 ±0.0943) as compared to that in the Rapamycin group (1.2136 ±0.6738)(t =5.1610,P ＜ 0.01) ;The incidences of acute rejection was significantly lower in the Rapamycin group as compared to that in the FK506 group after operation in the same period (x2 =2.2222,P ＜ 0.05).Conclusions FK506 may suppress the induction of immune tolerance after liver transplantation,while Rapamycin may play an important role in inducing and maintaining graft immune tolerance.Rapamycin is better than FK506 in preventing rejection reaction in liver cancer patients receiving liver transplant.
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ObjectiveTo evaluate the result of problem-based learning combined with Casebased learning teaching model in the clinical probation of digestive medicine.MethodsPBL combined CBL teaching method and traditional teaching method were used respectively among 120 medical students who were divided into two groups randomly. Educational effects were evaluated through examination and ques-tionnaire.Results The PBL combined CBL group test scores are significantly higher than traditional teaching group ( P＜0.05 ).96.4％ students thought it was necessary to have PBL combined CBL teaching.ConclusionsPBL combined CBL teaching method is an effective teaching method for medical students.